Prospective and Retrospective Study of Patients Undergoing Surgical Intervention for Spontaneous Intracerebral Hemorrhage- an Institutional Experience

Introduction: Spontaneous ICH accounts for approximately 10-20% of all strokes and is associated with a high morbidity and mortality. Surgery so far has been reserved only for patients with large hematomas and impending brain herniation. In addition, minimally invasive surgical techniques complemented by thrombolytic techniques seem to providing surprisingly good results. EVD insertion in acute hydrocephalus, fibrinolysis of IVH using recombinant tissue plasminogen activator (rtPA), or streptokinase are other indications for surgery, especially in IVH.This study evaluates the clinical outcome following surgical intervention.

Methods: In this study 93 patients with SICH were evaluated and underwent Surgical intervention as required in the form of evacuation of the clot with craniectomy as needed, EVD insertion where required. Follow up was done after 1 and 3 months and outcome of the patient was assessed using GCS, GOS and mRS

Results: The overall mortality was 31.2% (29 patients), of these 23(24.7%) patients died during hospitalization and 6 (6.4%) died within three months. For survivors after three months follow up 9(9.7%) patients had mRS score 1 showing no significant disability,21(22.6%) had score 2 showing slight disability, 13(14%) patients had score 3 showing moderate disability, 14(15.1%) patients had score 4 showing moderately severe disability, 7(7.5%) patients had score 5 showing severe disability.

Conclusion : We conclude that Spontaneous ICH is more common in elderly males, with h/o alcoholism with associated co-morbidities like HTN, IHD and Diabetes, however no significant impact on outcome was found.The parameters significantly affecting the outcome were: GCS at presentation, Focal Neurological Deficits, vomiting, associated IVH and midline shift. Decompressive craniectomy had no statistical added benefit over craniotomy in the outcome of the patient.