Medical versus surgical treatment in supratentorial intracerebral hemorrhage

Background and objectives

The optimal mode of treatment in spontaneous supratentorial intracerebral hemorrhage (SICH) is controversial. We assessed the value of hematoma evacuation in SICH in a case–control study.

Methods

One hundred and forty-five patients with SICH without tumor or vascular abnormalities. Indication for surgery were made upon admission in 11 and after clinical deterioration in 13 patients. Assessed were age, sex. Glasgow Coma Scale (GCS), pupillary reaction on admission, localisation, etiology and hematoma volume, presence of ventricular blood, and Glasgow Outcome Scale on discharge. From further analysis patients > 80 years or with hematoma volume < 10 ml were excluded. Statistical analysis included: (i) a multiple regression model to determine prognostic factors; (ii) comparison between medical and surgical patients; (iii) matching the 24 evacuated with 24 medical patients according to those parameters retained from the regression model and additionally to other suspected factors influencing outcome; (iv) comparison between both groups to confirm comparability; and (v) testing for different outcome between the groups.

Results

Prognostic factors were GCS, hematoma volume and location. All 24 evacuated patients could be matched to a medically treated patient regarding age, hematoma volume and location. GCS and pupillary reaction. Differences between both groups could not be detected. Outcome was not different between the medical and surgical group.

Conclusions

Hematoma evacuation does not improve outcome in supratentorial spontaneous hemorrhages. Since mainly deteriorating patients were evacuated, the only effect of hematoma evacuation may be to stop deterioration rather than to improve overall outcome.