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Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
International variations in surgical practice for spontaneous intracerebral hemorrhage
Barbara A Gregson1, A David Mendelow,
1Affiliation University of Newcastle Upon Tyne, Newcastle Upon Tyne, UK. barbara.gregson@ncl.ac.uk
Insights
Surgical intervention for spontaneous intracerebral hemorrhage varied significantly between centers. Patient characteristics alone did not explain these differences, highlighting the need for evidence-based treatment guidelines.
Area of Science:
- Neurosurgery
- Neurology
- Clinical Trials
Background:
- Spontaneous intracerebral hemorrhage (ICH) is a leading cause of death and disability.
- Current medical treatments lack convincing evidence of benefit.
- The role of surgical intervention in ICH management remains controversial.
Purpose of the Study:
- To assess the role and variability of surgical intervention for ICH within participating centers of the Surgical Trial in Intracerebral Hemorrhage (STICH).
Main Methods:
- Utilized screening logs from 42 centers covering 704 months.
- Recorded details of 1578 assessed patients, including trial inclusion status and surgical treatment.
- Analyzed patient characteristics and neurosurgeon treatment certainty.
Main Results:
- Neurosurgeons showed greater certainty in treating older patients, those with higher Glasgow Coma Scale (GCS) scores, and specific hematoma locations (basal ganglia, thalamus, right-sided).
- Surgical removal was more likely in younger patients, those with lower GCS scores, and lobar hematomas.
- Observed a wide variation in operation rates, from 74% in Lithuania to 2% in Hungary.
Conclusions:
- Disparities in surgical rates could not be solely attributed to differences in patient demographics or clinical presentation.
- The findings underscore the necessity for further research to establish evidence-based practices and reduce the influence of local customs in ICH treatment.
Background And Purpose:
Spontaneous intracerebral hemorrhage is a major cause of death and disability, yet there is no convincing evidence of the benefit of any medical treatment and the role of surgery remains controversial. The international randomized Surgical Trial in Intracerebral Hemorrhage (STICH) provided an opportunity to assess the role of surgery within the centers taking part.
Methods:
Screening logs were completed to record details of all patients assessed by the department, whether they were included in the trial, the reasons if they were not included, and whether they underwent surgery.
Results:
Logs were returned by 42 centers and cover 704 months. They include details on 1578 patients with characteristics comparable to STICH inclusion criteria. Neurosurgeons were more likely to express clinical certainty about treatment for older patients, patients with a higher Glasgow Coma Score scale, and patients in whom the hematoma was located on the right or in the basal ganglia or thalamus. Patients for whom the neurosurgeon was certain about treatment were more likely to have the hematoma removed if they were younger (62 versus 68 years of age), had a lower Glasgow Coma Scale score (10 versus 13), and had a lobar hematoma (49% versus 40%). The operation rate varied between 74% in Lithuania and 2% in Hungary.
Conclusions:
The difference in operation rates could not be explained by differences in patient characteristics alone. This finding demonstrates the need for further evidence to ensure that treatment for intracerebral hemorrhage is not governed by local custom.
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