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Prediction of Long-Term Outcome After Intracerebral Hemorrhage Surgery

Ebba Troberg1, Erik Kronvall1, Björn M Hansen1

  • 1Departments of Clinical Sciences and Neurosurgery, Lund University, Skane University Hospital, Lund, Sweden.

World Neurosurgery
|December 23, 2018
PubMed

Insights

Surgery for brain hemorrhage (ICH) had low mortality but most survivors experienced long-term disability. Pre-existing heart disease and consciousness level predicted mortality in ICH patients undergoing surgery.

Area of Science:

  • Neurosurgery
  • Neurology
  • Public Health

Background:

  • Surgery for spontaneous primary intracerebral hemorrhage (ICH) remains controversial.
  • Previous surgical trials focused on short-term mortality, with limited data on long-term functional outcomes.
  • This study retrospectively analyzed long-term outcomes for ICH patients undergoing craniotomy.

Purpose of the Study:

  • To evaluate the long-term functional outcomes of patients who underwent craniotomy for spontaneous intracerebral hemorrhage (ICH).
  • To identify predictors of mortality and functional outcome in surgically treated ICH patients.
  • To provide insights into the long-term impact of surgical intervention for ICH.

Main Methods:

  • Retrospective analysis of 229 patients over 15 years old who underwent ICH evacuation between 2003 and 2012.
  • Analysis of case fatality at 30 days, 1 year, and up to 10 years.
  • Long-term functional outcome assessed using the modified Rankin Scale (mRS) via telephone interview.

Main Results:

  • Overall 30-day and 1-year case fatality rates were 20% and 31%, respectively.
  • Supratentorial ICH had lower mortality (16% at 30 days, 27% at 1 year) than cerebellar ICH (29% at 30 days, 41% at 1 year).
  • Pre-existing heart disease and admission consciousness level were key mortality predictors. Of 185 patients with available long-term data, 24% had good outcomes (mRS 0-3), while 76% were severely disabled or deceased.

Conclusions:

  • The study demonstrated comparatively low case fatality for surgically treated ICH.
  • However, the majority of survivors experienced significant long-term dependency.
  • Pre-existing heart disease and initial level of consciousness consistently predicted mortality in this cohort.
Abstract

Keywords:
Intracerebral hemorrhageLong-term outcomePrognosisRisk factorsSurgery

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