Primary Supratentorial Haemorrhage - Surgery or no Surgery in an Indian Setup

Rise of hypertension among younger age group has increased the prevalence of intracranial haemorrhage. Conflicting reviews regarding the mode of treatment has been a concern to the treating physicians especially in a developing country like India. This study was undertaken to underline the importance of management and propose a local protocol for primary supra-tentorial haemorrhage.

Patients presenting with primary supratentorial (ST) haemorrhage fulfilling inclusion criteria are included in the study. Decompression craniotomy done in all the patients and the patient particulars noted. The primary outcome of death is correlated with various particulars and statistical analysis done with SPSS version 16.

Mean age of presentation was 54.2 years, ranging from 38-71years. Male comprised 82.1% (23 patients). Seven out of eight patients with Glasgow coma scale (GCS) ≤7 (87.5%) expired whereas only 3 out of 20 (15%) patients with GCS >7 expired. 50% of the patients with intracranial haemorrhage (ICH) in temporo-pari et al., (2/4) or in basal ganglia with cortical extension (5/10) expired whereas the mortality in cases of ICH in parietal lobe and frontal lobes were 25% (1/4) and 20% (2/10) respectively. Clot volume ≤100ml had a mortality of 19% (4/21) whereas the mortality was as high as 85.7% (6/7) with clot volume >100ml.

Emergency Craniotomy and Evacuation of the Hematoma could be a feasible option in between 40 ml to 100ml of Primary ST ICH without intra-ventricular extension. In cases of intra-ventricular extension of haematoma surgery is less helpful. Midline shift of 5 mm or more might be a poor prognostic factor.