Predictors of unfavourable outcome following surgical evacuation of hypertensive lobar and putaminal intracranial hemorrhage
Keywords:
predictors; hypertension; hemorrhage; putaminal.Abstract
Background: Intracerebral haemorrhage (ICH) is the second most common cause of stroke with a high case of fatality rate. Even with recent advances in the neuro intensive care, no specific treatment has been shown to improve outcomes and treatment is mainly supportive. In this context we wanted to evaluate the predictors of unfavourable outcome after surgical evacuation of hypertensive supratentorial intracerebral haemorrhage.
Materials and methods: This is a retrospective study of patients who underwent craniotomy for evacuation of putaminal or lobar hypertensive haemorrhage. Extended Glasgow Outcome Scale (GOSE) at six months is the primary outcome measure and length of hospital stay is the secondary outcome measure.
Results: There were a total of 48 patients who were operated for supratentorial hypertensive haemorrhage over the period of two and a half years. Mean age of the patient was 51.34 years. Nineteen of them were lobar haemorrhage while 29 were putaminal. Average duration since event till surgery was 29.46 hours. Mean GCS on arrival was 9.56. Mean length of hospital stay was 25.88 days. Mean GOSE at six months was 4.06. Overall mortality at six months was 25.8%. Putaminal haemorrhage was significantly associated with unfavourable GOSE (p =0.004). Duration of event prior to surgery did not appear to play any significant role in the prediction of outcome. Mean age of patients with favourable GOSE at six months was 43.25 versus 55.83 among patients with unfavourable GOSE (p=0.029). Mean GCS at presentation of patients with favourable GOSE at six months was 12.18 vs 8.47 among patients with unfavourable GOSE (p=0.008).
Conclusion: GCS on arrival and age of the patient is significantly related to the outcome after surgical evacuation of hypertensive supratentorial ICH. Putaminal haemorrhage has significantly higher unfavourable outcome. There is no difference in early versus late surgical intervention in hypertensive supratentorial ICH.
