Surgical and conservative treatment of patients with non-traumatic intracerebral hematoma: pros and cons

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BACKGROUND

The risk and benefits of early neurosurgical intervention in patients with non-traumatic intracerebral hematoma (NICH) are still unclear.

OBJECTIVE

To evaluate an effectiveness of early surgery in patients with NICH compared to primary conservative therapy.

MATERIAL AND METHODS

There were 115 patients with indications for surgery. The indications were supratentorial NICH over 30 cm³and GCS score >7 points. All patients were divided into 2 groups: the main group (n=59) — NICH removal within 24 hours; the control group (n=56) — conservative treatment only. Both groups were comparable by the main clinical, demographic and neuroimaging characteristics. We analyzed survival rates and functional status using Glasgow outcome scale extended (GOSE) 6 months later.

RESULTS

Median survival in the main group was 71 days vs. 11 days in the control group (p<0.05); cumulative 6-month survival — 46% and 34%, respectively (p>0.05). Surgical treatment resulted higher number of patients with severe (13% vs. 5%) and moderate disability (29% vs. 23%). There were 2% of patients with good recovery in the group of surgical treatment and 4% of patients after conservative management. However, between-group differences were not significant (p>0.05).

CONCLUSION

Early surgical evacuation of non-traumatic intracerebral hematoma is accompanied by less early postoperative mortality. There were no significant between-group differences in functional outcomes and survival rates after 6 months.

Keywords:

non-traumatic intracerebral hematoma

conservative treatment

surgical treatment

Glasgow outcome scale extended

Authors:

Borovsky A.A.

Belarusian State Medical University

Davidyan A.V.

Belarusian State Medical University

Shamkalovich A.V.

Belarusian State Medical University

Veevnik D.P.

Belarusian Medical Academy of Postgraduate Education

Fedulov A.S.

Belarusian State Medical University

SPIN RSCI: 1142-6530
Scopus AuthorID: 7003310844
ORCID: 0000-0001-7269-6228

Received:

11.07.2020

Accepted:

19.03.2021

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