Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study

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  • 1 Departments of Neurosurgery, Neurology, Radiology, and Pathology, University of Graz, Graz, Austria
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✓ A controlled randomized study of endoscopic evacuation versus medical treatment was performed in 100 patients with spontaneous supratentorial intracerebral (subcortical, putaminal, and thalamic) hematomas. Patients with aneurysms, arteriovenous malformations, brain tumors, or head injuries were excluded. Criteria for inclusion were as follows: patients' age between 30 and 80 years; a hematoma volume of more than 10 cu cm; the presence of neurological or consciousness impairment; the appropriateness of surgery from a medical and anesthesiological point of view; and the initiation of treatment within 48 hours after hemorrhage. The criteria of randomization were the location, size, and side of the hematoma as well as the patient's age, state of consciousness, and history of hypertension. Evaluation of outcome was performed 6 months after hemorrhage.

Surgical patients with subcortical hematomas showed a significantly lower mortality rate (30%) than their medically treated counterparts (70%, p < 0.05). Moreover, 40% of these patients had a good outcome with no or only a minimal deficit versus 25% in the medically treated group; the difference was statistically significant for operated patients with no postoperative deficit (p < 0.01). Surgical patients with hematomas smaller than 50 cu cm made a significantly better functional recovery than did patients of the medically treated group, but had a comparable mortality rate. By contrast, patients with larger hematomas showed significantly lower mortality rates after operation but had no better functional recovery than the medically treated group. This effect from surgery was limited to patients in a preoperatively alert or somnolent state; stuporous or comatose patients had no better outcome after surgery. The outcome of surgical patients with putaminal or thalamic hemorrhage was no better than for those with medical treatment; however, there was a trend toward better quality of survival and chance of survival in the operated group.

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  • 1.

    Auer LM, , Holzer P, & Ascher PW, et al: Endoscopic neurosurgery. Acta Neurochir 90:114, 1988 Auer LM, Holzer P, Ascher PW, et al: Endoscopic neurosurgery. Acta Neurochir 90:1–14, 1988

    • Search Google Scholar
    • Export Citation
  • 2.

    Brott T, , Thalinger K, & Hertzberg V: Hypertension as a risk factor for spontaneous intracerebral hemorrhage. Stroke 17:10781083, 1986 Brott T, Thalinger K, Hertzberg V: Hypertension as a risk factor for spontaneous intracerebral hemorrhage. Stroke 17:1078–1083, 1986

    • Search Google Scholar
    • Export Citation
  • 3.

    Calandre L, , Arnal C, & Fernandez Ortega J, et al: Risk factors for spontaneous cerebral hematomas. Case-control study. Stroke 17:11261128, 1986 Calandre L, Arnal C, Fernandez Ortega J, et al: Risk factors for spontaneous cerebral hematomas. Case-control study. Stroke 17:1126–1128, 1986

    • Search Google Scholar
    • Export Citation
  • 4.

    Dolinskas CA, , Bilaniuk LT, & Zimmermann RA, et al: Computed tomography of intracerebral hematomas. II. Radionuclide and transmission CT studies of the perihematoma region. AJR 129:689692, 1977 Dolinskas CA, Bilaniuk LT, Zimmermann RA, et al: Computed tomography of intracerebral hematomas. II. Radionuclide and transmission CT studies of the perihematoma region. AJR 129:689–692, 1977

    • Search Google Scholar
    • Export Citation
  • 5.

    Fisher CM: The pathology and pathogenesis of intracerebral hemorrhage, in Field WS (ed): Pathogenesis and Treatment of Cerebrovascular Disease. Springfield, Ill: Charles C Thomas, 1961, pp 295317 Fisher CM: The pathology and pathogenesis of intracerebral hemorrhage, in Field WS (ed): Pathogenesis and Treatment of Cerebrovascular Disease. Springfield, Ill: Charles C Thomas, 1961, pp 295–317

    • Search Google Scholar
    • Export Citation
  • 6.

    Hier DB, , Davis KR, & Richardson EP Jr, et al: Hypertensive putaminal hemorrhage. Ann Neurol 1:152159, 1977 Hier DB, Davis KR, Richardson EP Jr, et al: Hypertensive putaminal hemorrhage. Ann Neurol 1:152–159, 1977

    • Search Google Scholar
    • Export Citation
  • 7.

    Kingman TA, , Mendelow AD, & Graham DI, et al: Experimental intracerebral mass: time-related effects on local cerebral blood flow. J Neurosurg 67:732738, 1987 Kingman TA, Mendelow AD, Graham DI, et al: Experimental intracerebral mass: time-related effects on local cerebral blood flow. J Neurosurg 67:732–738, 1987

    • Search Google Scholar
    • Export Citation
  • 8.

    Mendelow AD, , Bullock R, & Nath FP, et al: Experimental intracerebral haemorrhage: intracranial pressure changes and cerebral blood flow, in Miller JD, , Teasdale GM, & Rowan JO, et al (eds): Intracranial Pressure VI. Berlin: Springer-Verlag, 1986, pp 515520 Mendelow AD, Bullock R, Nath FP, et al: Experimental intracerebral haemorrhage: intracranial pressure changes and cerebral blood flow, in Miller JD, Teasdale GM, Rowan JO, et al (eds): Intracranial Pressure VI. Berlin: Springer-Verlag, 1986, pp 515–520

    • Search Google Scholar
    • Export Citation
  • 9.

    Nath FP, , Jenkins A, & Mendelow AD, et al: Early hemodynamic changes in experimental intracerebral hemorrhage. J Neurosurg 65:697703, 1986 Nath FP, Jenkins A, Mendelow AD, et al: Early hemodynamic changes in experimental intracerebral hemorrhage. J Neurosurg 65:697–703, 1986

    • Search Google Scholar
    • Export Citation
  • 10.

    Ojemann RG, & Mohr JP: Hypertensive brain hemorrhage. Clin Neurosurg 23:220244, 1975 Ojemann RG, Mohr JP: Hypertensive brain hemorrhage. Clin Neurosurg 23:220–244, 1975

    • Search Google Scholar
    • Export Citation
  • 11.

    Sinar EJ, , Mendelow AD, & Graham DI, et al: Experimental intracerebral hemorrhage: effects of a temporary mass lesion. J Neurosurg 66:568576, 1987 Sinar EJ, Mendelow AD, Graham DI, et al: Experimental intracerebral hemorrhage: effects of a temporary mass lesion. J Neurosurg 66:568–576, 1987

    • Search Google Scholar
    • Export Citation
  • 12.

    Sussman BJ, , Barber JB, & Goald H: Experimental intracerebral hematoma. Reduction of oxygen tension in brain and cerebrospinal fluid. J Neurosurg 41:177186, 1974 Sussman BJ, Barber JB, Goald H: Experimental intracerebral hematoma. Reduction of oxygen tension in brain and cerebrospinal fluid. J Neurosurg 41:177–186, 1974

    • Search Google Scholar
    • Export Citation
  • 13.

    Suzuki J, & Ebina T: Sequential changes in tissue surrounding ICH, in Pia HW, , Langmaid C, & Zierski J (eds): Spontaneous Intracerebral Hematomas. Advances in Diagnosis and Therapy. Berlin: Springer-Verlag, 1980, pp 121128 Suzuki J, Ebina T: Sequential changes in tissue surrounding ICH, in Pia HW, Langmaid C, Zierski J (eds): Spontaneous Intracerebral Hematomas. Advances in Diagnosis and Therapy. Berlin: Springer-Verlag, 1980, pp 121–128

    • Search Google Scholar
    • Export Citation

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