Early Surgical Treatment for Supratentorial Intracerebral Hemorrhage

• DOI: 10.1161/01.str.30.9.1833
• Publication Date: 2011-06-17T20:08:03Z
• Authors: Mario Zuccarello; Thomas Brott; Laurent Derex; Rashmi Kothari; Laura Sauerbeck; John Tew; Harry Van Loveren; Hwa-Shain Yeh; Thomas Tomsick; Arthur Pancioli; Jane Khoury; Joseph Broderick
• Keywords: Glasgow Outcome Scale; Clinical endpoint

Background and Purpose —The safety the effectiveness of surgical treatment spontaneous intracerebral hemorrhage (ICH) remain controversial. To investigate feasibility urgent evacuation ICH, we conducted a small, randomized study early versus current nonoperative management in patients with supratentorial ICH. Methods —Patients ICH who presented to 1 university 2 community hospitals were or best medical treatment. Principal eligibility criteria volume >10 cm 3 on baseline CT scan focal neurological deficit, Glasgow Coma Scale score >4 at time enrollment, randomization therapy within 24 hours symptom onset, surgery randomization, no evidence for ruptured aneurysm arteriovenous malformation. The primary end point was 3-month Outcome (GOS). A good outcome defined as GOS >3. Results —Twenty over months, 9 intervention 11 median from onset symptoms presentation treating 17 minutes, hour 20 8 35 minutes. likelihood (primary measure: >3) group (56%) did not differ significantly (36%). There significant difference mortality months. Analysis secondary measures showed nonsignificant trend toward better GOS, Barthel Index, Rankin National Institutes Health Stroke (4 14; P =0.04). Conclusions —Very acute is difficult achieve but feasible academic centers hospitals. less morbidity warrants further investigation very clot removal larger clinical trials.