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Dangayach NS, Morozov M, Cossentino I, Liang J, Chada D, Bageac D, Salgado L, Malekebu W, Kellner C, Bederson J. A Narrative Review of Interhospital Transfers for Intracerebral Hemorrhage. World Neurosurg 2024; 190:1-9. [PMID: 38830508 DOI: 10.1016/j.wneu.2024.05.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/05/2024]
Abstract
Of the 750,000 strokes in the United States every year, 15% patients suffer from hemorrhagic stroke. Intracerebral hemorrhage (ICH) is a subtype of hemorrhagic stroke. Despite advances in acute management, patients with hemorrhagic stroke continue to suffer from high mortality and survivors suffer from multidomain impairments in the physical, cognitive, and mental health domains which could last for months to years from their index stroke. Long-term prognosis after ICH is critically dependent on the quality and efficacy of care a patient receives during the acute phase of care. With ongoing care consolidation in stroke systems of care, the number of ICH patients who need to undergo interhospital transfers (IHTs) is increasing. However, the associations between IHT and ICH outcomes have not been well described in literature. In this review, we describe the epidemiology of IHT for ICH, the relationship between IHT and ICH patient outcomes, and proposed improvements to the IHT process to ensure better long-term patient outcomes. Our review indicates that evidence regarding the safety and benefit of IHT for ICH patients is conflicting, with some studies reporting poorer outcomes for transferred patients compared to direct admissions via emergency rooms and other studies showing no effect on outcomes. The American Heart Association guidelines for ICH provide recommendations for timely blood pressure control and anticoagulation reversal to improve patient outcomes. The American Heart Association stroke systems of care guidelines provide recommendations for transfer agreements and but do not provide details on how patients should be managed while undergoing IHT. Large, prospective, and multicenter studies comparing outcomes of IHT patients to direct admissions are necessary to provide more definitive guidance to optimize IHT protocols and aid clinical decision-making.
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Affiliation(s)
- Neha S Dangayach
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Masha Morozov
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ian Cossentino
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John Liang
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Deeksha Chada
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Devin Bageac
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laura Salgado
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Wheatonia Malekebu
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christopher Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joshua Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Jakobsson J, Redebrandt HN, Tobieson L, Bartek J, Bartley A, Troberg E, Mirza S, Tsitsopoulos PP, Marklund N, Fahlström A. Long-Term Functional Outcome and Quality of Life After Surgical Evacuation of Spontaneous Supratentorial Intracerebral Hemorrhage: Results from a Swedish Nationwide Cohort. World Neurosurg 2023; 170:e351-e363. [PMID: 36368454 DOI: 10.1016/j.wneu.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate long-term survival, neurologic outcome, and quality of life in patients with spontaneous supratentorial intracerebral hemorrhage (ICH) treated with craniotomy and hematoma evacuation. METHODS A nationwide multicenter retrospective analysis of 341 patients who underwent craniotomy and evacuation of supratentorial ICH between January 1, 2011, and December 31, 2015, was performed. Baseline characteristics associated with 6-month mortality and long-term mortality were investigated. Survivors received a questionnaire about their state of health from which EuroQol 5D (EQ-5D) and modified Rankin scale (mRS) were obtained. Predictors of mortality, unfavorable outcome, and life quality were analyzed. RESULTS The mean follow-up time was 55.2 months. Predictors of 6-month mortality in multiple regression analysis were age ≥75 years, previous myocardial infarction, lower level of consciousness, and mechanical ventilation. Predictors of long-term mortality were higher age and mechanical ventilation. At follow-up, 49.5% of survivors had a favorable neurologic outcome (mRS ≤3). Predictors of an unfavorable functional outcome were higher age and ICH volume ≥50 mL. The mean EQ-5D health index was 0.719, and the mean EQ-5D visual analog scale score was 53.9. In multiple regression, only a higher mRS score was significantly associated with worse life quality. CONCLUSIONS Knowledge about survival, functional outcome, and life quality as well as their predictors in this specific patient group is previously primarily described in short-term follow-up. This multicenter study provides novel information in the long-term perspective, which is important for improved surgical decision-making and prognostication.
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Affiliation(s)
- Johan Jakobsson
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Henrietta Nittby Redebrandt
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Neurosurgery, Lund, Sweden
| | - Lovisa Tobieson
- Department of Neurosurgery in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Jiri Bartek
- Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Andreas Bartley
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Ebba Troberg
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Neurosurgery, Lund, Sweden
| | - Sadia Mirza
- Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Parmenion P Tsitsopoulos
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden; Department of Neurosurgery, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Niklas Marklund
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Neurosurgery, Lund, Sweden
| | - Andreas Fahlström
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden; Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Australia.
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Shrestha D, Sharma U, Shrestha J, Nepal G, Shrestha B, Shrestha P, Acharya S, Gurung P, Shrestha R, Dhakal S, Rajbhandari P, Pant B. Surgical Management among Patients with Spontaneous Supratentorial Intracerebral Haemorrhage Admitted in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:697-701. [PMID: 36705228 PMCID: PMC9446498 DOI: 10.31729/jnma.7178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 07/28/2022] [Indexed: 01/31/2023] Open
Abstract
Introduction Spontaneous intracerebral haemorrhage is the second most common form of stroke and the most deadly one. An understanding of changing trends in the epidemiology of intracerebral haemorrhage prevalence, its risk factors, current practice in management, case fatality, and long-term outcome is essential to measure the effectiveness of stroke prevention and various treatment efforts. The objective of this study was to find out the prevalence of surgical management among patients with spontaneous supratentorial intracerebral haemorrhage in a tertiary centre. Methods A descriptive cross-sectional study was conducted in the Department of Neurosurgery from January 2017 to December 2019. Ethical approval was obtained from the Institutional Review Committee (Reference number: 06/2020/IRC-ANIAS). A convenience sampling method was used. Data of the patients were retrieved from online medical records. Point estimate and 95% Confidence Interval were calculated. Results Among 221 patients with spontaneous supratentorial intracerebral haemorrhage, 115 (52.04%) (45.45-58.63, 95% Confidence Interval) underwent surgical management. In-hospital mortality was seen in 23 (20%) and survivors at 3 months were 78 (67.82%) patients. Conclusions The prevalence of surgical management among spontaneous supratentorial intracerebral haemorrhages was higher than in other studies done in a similar setting. Keywords intracerebral haemorrhage; mortality; surgical procedure.
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Affiliation(s)
- Dinuj Shrestha
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal,Correspondence: Dr Dinuj Shrestha, Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal. , Phone: +977-9841211502
| | - Upama Sharma
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Janam Shrestha
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Gopi Nepal
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Bishal Shrestha
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Pranaya Shrestha
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Samir Acharya
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Pritam Gurung
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Resha Shrestha
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Sudan Dhakal
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Pravesh Rajbhandari
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Basant Pant
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
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Zhou H, Cha Z, Wang L, Chen M, Zhang Q, Tang J. Clinical efficacy and safety of neuroendoscopic surgery for severe thalamic hemorrhage with ventricle encroachment. Neurosurg Rev 2022; 45:2701-2708. [PMID: 35381930 DOI: 10.1007/s10143-022-01782-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 11/21/2022]
Abstract
To summarize and analyze the clinical efficacy and safety of neuroendoscopic surgery (NES) in the treatment of patients for severe thalamic hemorrhage with ventricle encroachment (THVE). Eighty-three patients with severe THVE were treated in the Neurosurgery Department of Anqing Hospital Affiliated to Anhui Medical University from July 2019 to August 2021. Our study was approved by the ethics committee. The patients were randomly divided into NES group and extraventricular drainage (EVD) group. The hospital stay, Glasgow coma scale (GCS) scores on the 1st and 14th days postoperatively, the incidence of intracranial infections, and the clearance of postoperative hematomas were compared and analyzed between the two groups. The patients had follow-up evaluations 6 months postoperatively. The prognosis was evaluated based on the activity of daily living (ADL) score. A head CT or MRI was obtained to determine whether there was hydrocephalus, cerebral infarction, or other related complications. Eighty-three patients were randomly divided into 41 cases of NES group and 42 cases of EVD group. The length of postoperative hospital stay was 17.42 ± 1.53 days, the GCS scores were 6.56 ± 0.21, and 10.83 ± 0.36 on days 1 and 14, respectively; intracranial infections occurred in 3 patients (7.31%) and the hematoma clearance rate was 83.6 ± 5.18% in the NES group, all of which were significantly better than the EVD group (P < 0.05). After 6 months of follow-up, 28 patients (68.29%) had a good prognosis, 5 patients (12.19%) died, and 4 patients (9.75%) had hydrocephalus in the NES group. In the EVD group, the prognosis was good in 15 patients (35.71%), 12 patients (28.57%) died, and 17 patients (40.47%) had hydrocephalus. The prognosis, mortality rate, and incidence of hydrocephalus in the NES group were significantly better than the EVD group (P < 0.05). Compared to traditional EVD, NES for severe THVE had a higher hematoma clearance rate, and fewer intracranial infections and patients with hydrocephalus, which together improve the clinical prognosis and is thus recommended for clinical use.
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Affiliation(s)
- Heping Zhou
- Department of Neurosurgery, Anqing Affiliated Hospital of Anhui Medical University, Anqing, 246003, Anhui Province, People's Republic of China.
| | - Zhengjiang Cha
- Department of Neurosurgery, Anqing Affiliated Hospital of Anhui Medical University, Anqing, 246003, Anhui Province, People's Republic of China
| | - Lei Wang
- Department of Neurology, Anqing Hospital Affiliated to Anhui Medical University, Anqing, Anhui Province, People's Republic of China
| | - Min Chen
- Department of Neurosurgery, Anqing Affiliated Hospital of Anhui Medical University, Anqing, 246003, Anhui Province, People's Republic of China
| | - Qingchao Zhang
- Department of Neurosurgery, Anqing Affiliated Hospital of Anhui Medical University, Anqing, 246003, Anhui Province, People's Republic of China
| | - Jian Tang
- Department of Neurosurgery, Anqing Affiliated Hospital of Anhui Medical University, Anqing, 246003, Anhui Province, People's Republic of China
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Behle B, Beseoglu K, Beez T, Petridis AK, Fischer I, Hänggi D, Steiger HJ. Profile and Prognosis of Spontaneous Lobar Intracerebral Hemorrhage: Comparison of 6-month Survival with STICH II and the MISTIE III Lobar Hemorrhage Subset. J Neurol Surg A Cent Eur Neurosurg 2021; 83:20-26. [PMID: 34030185 DOI: 10.1055/s-0041-1725957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Randomized trials on spontaneous lobar intracerebral hemorrhage (ICH) provided no convincing evidence of the superiority of surgical treatment. Since recruitment in the trials was under the premise of equipoise, a selection bias toward patients who did not need surgery or were in hopeless condition must be suspected. The aim of the actual analysis was to compare outcome and patient profile of an unselected hospital series with recent randomized trials and to develop a prognostic model. METHODS Of 821 patients with spontaneous ICH managed at the neurosurgical department of the University Hospital Düsseldorf between 2013 and 2018, 159 had lobar bleedings. Patient characteristics, hematoma volume, treatment modality, and 6-month survival were compared with STICH II and the subset of lobar hemorrhage in the MISTIE III trial. In addition, a prognostic model for 6-month survival in our patients was developed using a random forest classifier. RESULTS One hundred and seven patients were managed by surgical evacuation of the hematoma and 52 without surgical evacuation. Median hemorrhage volume in our surgical cohort was 66 and 42 mL in the conservative cohort, compared with 38 and 36 mL in the STICH II trial, and 46 and 47 mL in the surgical and conservative MISTIE III lobar hemorrhage subset. Median initial Glasgow Coma Scale (GCS) score was 12 in our surgical group and 11 in the conservative group, compared with 13 in the STICH II cohorts and 12 in the MISTIE III lobar hemorrhage subset. Median age in our surgical and conservative cohorts was 73 and 74 years, respectively, compared with 65 years in both STICH II cohorts and 68 years in the MISTIE II subsets. Twenty-nine percent of our surgical cohort and 55% of our conservatively managed patients deceased within the first 6 months, compared with 18 and 24%, respectively, in STICH II and 17 and 24% in the MISTIE III subset. Our prognostic model identified large hemorrhage volumes and low admission GCS score as main unfavorable prognostic factors for 6-month survival. The random forest classifier achieved a predictive accuracy of 78% and an area under curve (AUC)- value of 88% regarding survival at 6 months, on a test set independent of the training set. CONCLUSIONS In comparison with our surgical group, the STICH II and MISTIE III cohorts, recruited under the premise of physician equipoise, underrepresented patients with large ICHs. The cohorts in the randomized trials were therefore biased toward patients with a favorable perspective under conservative management. Initial hematoma volume and admission GCS were the main prognostic factors in our patients.
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Affiliation(s)
- Berthold Behle
- Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany
| | - Kerim Beseoglu
- Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany
| | - Thomas Beez
- Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Igor Fischer
- Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany
| | - Hans-Jakob Steiger
- Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany
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Prolonged Mechanical Ventilation in Patients with Deep-Seated Intracerebral Hemorrhage: Risk Factors and Clinical Implications. J Clin Med 2021; 10:jcm10051015. [PMID: 33801392 PMCID: PMC7958618 DOI: 10.3390/jcm10051015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 12/14/2022] Open
Abstract
While management of patients with deep-seated intracerebral hemorrhage (ICH) is well established, there are scarce data on patients with ICH who require prolonged mechanical ventilation (PMV) during the course of their acute disease. Therefore, we aimed to determine the influence of PMV on mortality in patients with ICH and to identify associated risk factors. From 2014 to May 2020, all patients with deep-seated ICH who were admitted to intensive care for >3 days were included in further analyses. PMV is defined as receiving mechanical ventilation for more than 7 days. A total of 42 out of 94 patients (45%) with deep-seated ICH suffered from PMV during the course of treatment. The mortality rate after 90 days was significantly higher in patients with PMV than in those without (64% versus 22%, p < 0.0001). Multivariate analysis identified “ICH volume >30 mL” (p = 0.001, OR 5.3) and “admission SOFA score > 5” (p = 0.007, OR 4.2) as significant and independent predictors for PMV over the course of treatment in deep-seated ICH. With regard to the identified risk factors for PMV occurrence, these findings might enable improved guidance of adequate treatment at the earliest possible stage and lead to a better estimation of prognosis in the course of ICH treatment.
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Schuss P, Bode C, Borger V, Coch C, Güresir Á, Hadjiathanasiou A, Hamed M, Kuchelmeister K, Lehmann F, Müller M, Schneider M, Solymosi L, Vatter H, Velten M, Güresir E. MR-Imaging and Histopathological Diagnostic Work-Up of Patients with Spontaneous Lobar Intracerebral Hemorrhage: Results of an Institutional Prospective Registry Study. Diagnostics (Basel) 2021; 11:diagnostics11020368. [PMID: 33671532 PMCID: PMC7926429 DOI: 10.3390/diagnostics11020368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/15/2021] [Accepted: 02/19/2021] [Indexed: 02/06/2023] Open
Abstract
Intracerebral hemorrhage (ICH) is a frequently disabling or fatal disease. The localization of ICH often allows an etiological association. However, in atypical/lobar ICH, the cause of bleeding is less obvious. Therefore, we present prospective histopathological and radiological studies which were conducted within the diagnostic workup to identify causes for lobar ICH other than hypertension. From 2016 to 2018, 198 patients with spontaneous, non-traumatic ICH requiring neurosurgical monitoring were enrolled in an institutional prospective patient registry. Patients with deep-seated ICH and/or hemorrhagically transformed cerebral infarcts were excluded from further analysis. Data to evaluate the source of bleeding based on histopathological and/or radiological workup were prospectively evaluated and analyzed. After applying the inclusion criteria and excluding patients with incomplete diagnostic workup, a total of 52 consecutive patients with lobar ICH were further analyzed. Macrovascular disease was detected in 14 patients with lobar ICH (27%). In 11 patients, diagnostic workup identified cerebral amyloid angiopathy-related ICH (21%). In addition, five patients with tumor-related ICH (10%) and six patients with ICH based on infectious pathologies (11%) were identified. In four patients, the cause of bleeding remained unknown despite extensive diagnostic workup (8%). The present prospective registry study demonstrates a higher probability to identify a cause of bleeding other than hypertension in patients with lobar ICH. Therefore, a thorough diagnostic work-up in patients with ICH is essential to accelerate treatment and further improve outcome or prevent rebleeding.
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Affiliation(s)
- Patrick Schuss
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (V.B.); (Á.G.); (A.H.); (M.H.); (M.S.); (H.V.); (E.G.)
- Correspondence:
| | - Christian Bode
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (C.B.); (F.L.); (M.V.)
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (V.B.); (Á.G.); (A.H.); (M.H.); (M.S.); (H.V.); (E.G.)
| | - Christoph Coch
- Study Center Bonn (SZB), Clinical Study Core Unit, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany;
| | - Ági Güresir
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (V.B.); (Á.G.); (A.H.); (M.H.); (M.S.); (H.V.); (E.G.)
| | - Alexis Hadjiathanasiou
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (V.B.); (Á.G.); (A.H.); (M.H.); (M.S.); (H.V.); (E.G.)
| | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (V.B.); (Á.G.); (A.H.); (M.H.); (M.S.); (H.V.); (E.G.)
| | - Klaus Kuchelmeister
- Institute of Neuropathology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany;
| | - Felix Lehmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (C.B.); (F.L.); (M.V.)
| | - Marcus Müller
- Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany;
| | - Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (V.B.); (Á.G.); (A.H.); (M.H.); (M.S.); (H.V.); (E.G.)
| | - László Solymosi
- Department of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany;
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (V.B.); (Á.G.); (A.H.); (M.H.); (M.S.); (H.V.); (E.G.)
| | - Markus Velten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (C.B.); (F.L.); (M.V.)
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (V.B.); (Á.G.); (A.H.); (M.H.); (M.S.); (H.V.); (E.G.)
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Patel SK, Saleh MS, Body A, Zuccarello M. Surgical Interventions for Supratentorial Intracranial Hemorrhage: The Past, Present, and Future. Semin Neurol 2021; 41:54-66. [PMID: 33511606 DOI: 10.1055/s-0040-1722639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Spontaneous supratentorial intracranial hemorrhage is extremely disabling and is associated with high mortality. Primary treatment for patients with this disease process is maximal medical management with blood pressure control and correction of clotting disorders due to comorbid conditions or medications. Over the past decade, significant strides have been made in understanding the benefits of surgical intervention in the treatment of intracranial hemorrhage through multiple clinical trials. In this article, we review the evolution of surgical treatments beginning with the STICH trials, discuss new developments with minimally invasive surgical strategies, and provide a brief update regarding ongoing trials and future directions in the treatment of spontaneous supratentorial intracranial hemorrhage.
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Affiliation(s)
- Smruti K Patel
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mohamed S Saleh
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alaina Body
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mario Zuccarello
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.,University of Cincinnati Gardner Neuroscience Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Rychen J, O'Neill A, Lai LT, Bervini D. Natural history and surgical management of spontaneous intracerebral hemorrhage: a systematic review. J Neurosurg Sci 2020; 64:558-570. [PMID: 32972110 DOI: 10.23736/s0390-5616.20.04940-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Management of spontaneous intracerebral hemorrhage (ICH) remains controversial despite efforts to produce high level evidence in the past few years. We systematically examined the pooled literature data on the natural history and surgical management of ICH. EVIDENCE ACQUISITION A systematic review was performed using the PubMed and Embase databases, encompassing English, full-text articles, reporting treatment outcomes for the conservative and surgical management of ICH. EVIDENCE SYNTHESIS A total of 91 studies met the eligibility criteria (total of 16,411 ICH cases). The most common locations for an ICH were the basal ganglia for both the conservative (68.7%) and surgical cohorts (58.4%). Patients in the non-operative group (40.5%) were older (mean age 62.9 years; range 12.0-94.0), had a higher Glasgow Coma Scale (GCS) score at presentation (mean GCS 10.2; range 3-15) and lower ICH volume (mean 36.9 mL). When managed non-operatively, a favorable functional outcome was encountered in 25.7% (95% CI 16.9-34.5) of patients, with a 22.2% (95% CI 16.6-27.8) mortality rate. Patients who underwent surgery (59.5%) were younger (mean age 58.8 years; range 12.0-94.0), had a lower GCS at presentation (mean GCS 8.2; range 3-15) and larger ICH volume (mean 58.3 mL; range 8.2-140.0). Craniotomy with hematoma evacuation was the preferred surgical technique (38.6%). A favorable functional outcome was encountered in 29.8% (95% CI 23.8-35.8) of operated patients, with a 21.3% (95% CI 16.3-26.3) mortality rate. CONCLUSIONS For many ICH cases, the reviewed literature allows to define surgical and conservative candidates. However, there are still some ICH-cases where management remains controversial.
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Affiliation(s)
- Jonathan Rychen
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
| | - Anthea O'Neill
- Department of Neurosurgery, Monash Health, Melbourne, Australia
| | - Leon T Lai
- Department of Neurosurgery, Monash Health, Melbourne, Australia
| | - David Bervini
- Department of Neurosurgery, University Hospital of Bern, Bern, Switzerland -
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Fahlström A, Nittby Redebrandt H, Zeberg H, Bartek J, Bartley A, Tobieson L, Erkki M, Hessington A, Troberg E, Mirza S, Tsitsopoulos PP, Marklund N. A grading scale for surgically treated patients with spontaneous supratentorial intracerebral hemorrhage: the Surgical Swedish ICH Score. J Neurosurg 2020; 133:800-807. [PMID: 31443074 DOI: 10.3171/2019.5.jns19622] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/16/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors aimed to develop the first clinical grading scale for patients with surgically treated spontaneous supratentorial intracerebral hemorrhage (ICH). METHODS A nationwide multicenter study including 401 ICH patients surgically treated by craniotomy and evacuation of a spontaneous supratentorial ICH was conducted between January 1, 2011, and December 31, 2015. All neurosurgical centers in Sweden were included. All medical records and neuroimaging studies were retrospectively reviewed. Independent predictors of 30-day mortality were identified by logistic regression. A risk stratification scale (the Surgical Swedish ICH [SwICH] Score) was developed using weighting of independent predictors based on strength of association. RESULTS Factors independently associated with 30-day mortality were Glasgow Coma Scale (GCS) score (p = 0.00015), ICH volume ≥ 50 mL (p = 0.031), patient age ≥ 75 years (p = 0.0056), prior myocardial infarction (MI) (p = 0.00081), and type 2 diabetes (p = 0.0093). The Surgical SwICH Score was the sum of individual points assigned as follows: GCS score 15-13 (0 points), 12-5 (1 point), 4-3 (2 points); age ≥ 75 years (1 point); ICH volume ≥ 50 mL (1 point); type 2 diabetes (1 point); prior MI (1 point). Each increase in the Surgical SwICH Score was associated with a progressively increased 30-day mortality (p = 0.0002). No patient with a Surgical SwICH Score of 0 died, whereas the 30-day mortality rates for patients with Surgical SwICH Scores of 1, 2, 3, and 4 were 5%, 12%, 31%, and 58%, respectively. CONCLUSIONS The Surgical SwICH Score is a predictor of 30-day mortality in patients treated surgically for spontaneous supratentorial ICH. External validation is needed to assess the predictive value as well as the generalizability of the Surgical SwICH Score.
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Affiliation(s)
- Andreas Fahlström
- 1Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala University Hospital, Uppsala
| | | | - Hugo Zeberg
- 3Department of Neuroscience, Karolinska Institutet
| | - Jiri Bartek
- 4Department of Medicine and Clinical Neuroscience, Neurosurgery, Karolinska Institutet, Karolinska University Hospital, Stockholm
- 5Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Andreas Bartley
- 6Department of Clinical Neuroscience, Neurosurgery, University of Gothenburg, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg
| | - Lovisa Tobieson
- 7Department of Clinical and Experimental Medicine, Neurosurgery, Linköping University, Linköping University Hospital, Linköping
| | - Maria Erkki
- 8Department of Clinical Neuroscience, Neurosurgery, Umeå University, Umeå University Hospital, Umeå, Sweden; and
| | - Amel Hessington
- 1Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala University Hospital, Uppsala
| | - Ebba Troberg
- 2Department of Clinical Sciences Lund, Neurosurgery, Lund University, Skane University Hospital, Lund
| | - Sadia Mirza
- 4Department of Medicine and Clinical Neuroscience, Neurosurgery, Karolinska Institutet, Karolinska University Hospital, Stockholm
| | - Parmenion P Tsitsopoulos
- 1Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala University Hospital, Uppsala
| | - Niklas Marklund
- 1Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala University Hospital, Uppsala
- 2Department of Clinical Sciences Lund, Neurosurgery, Lund University, Skane University Hospital, Lund
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Fahlström A, Tobieson L, Redebrandt HN, Zeberg H, Bartek J, Bartley A, Erkki M, Hessington A, Troberg E, Mirza S, Tsitsopoulos PP, Marklund N. Differences in neurosurgical treatment of intracerebral haemorrhage: a nation-wide observational study of 578 consecutive patients. Acta Neurochir (Wien) 2019; 161:955-965. [PMID: 30877470 PMCID: PMC6484090 DOI: 10.1007/s00701-019-03853-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/13/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Supratentorial intracerebral haemorrhage (ICH) carries an excessive mortality and morbidity. Although surgical ICH treatment can be life-saving, the indications for surgery in larger cohorts of ICH patients are controversial and not well defined. We hypothesised that surgical indications vary substantially among neurosurgical centres in Sweden. OBJECTIVE In this nation-wide retrospective observational study, differences in treatment strategies among all neurosurgical departments in Sweden were evaluated. METHODS Patient records, neuroimaging and clinical outcome focused on 30-day mortality were collected on each operated ICH patient treated at any of the six neurosurgical centres in Sweden from 1 January 2011 to 31 December 2015. RESULTS In total, 578 consecutive surgically treated ICH patients were evaluated. There was a similar incidence of surgical treatment among different neurosurgical catchment areas. Patient selection for surgery was similar among the centres in terms of patient age, pre-operative level of consciousness and co-morbidities, but differed in ICH volume, proportion of deep-seated vs. lobar ICH and pre-operative signs of herniation (p < .05). Post-operative patient management strategies, including the use of ICP-monitoring, CSF-drainage and mechanical ventilation, varied among centres (p < .05). The 30-day mortality ranged between 10 and 28%. CONCLUSIONS Although indications for surgical treatment of ICH in the six Swedish neurosurgical centres were homogenous with regard to age and pre-operative level of consciousness, important differences in ICH volume, proportion of deep-seated haemorrhages and pre-operative signs of herniation were observed, and there was a substantial variability in post-operative management. The present results reflect the need for refined evidence-based guidelines for surgical management of ICH.
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Affiliation(s)
- Andreas Fahlström
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden.
| | - Lovisa Tobieson
- Department of Neurosurgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Henrietta Nittby Redebrandt
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Hugo Zeberg
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jiri Bartek
- Department of Medicine and Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Andreas Bartley
- Department of Clinical Neuroscience, Neurosurgery, University of Gothenburg, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Erkki
- Department of Clinical Neuroscience, Neurosurgery, Umeå University, Umeå University Hospital, Umeå, Sweden
| | - Amel Hessington
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Ebba Troberg
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Sadia Mirza
- Department of Medicine and Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Parmenion P Tsitsopoulos
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Niklas Marklund
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
- Department of Neurosurgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, Skane University Hospital, Lund, Sweden
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