Management of spontaneous supratentorial intracerebral hemorrhage a comparative study between surgical and medical treatment

To study and compare the effectiveness and outcome of the surgical treatment versus medical management of patients with spontaneous supratentorial intracerebral hemorrhage [ICH]. A comprehensive review of 35 patients with spontaneous supratentorial ICH is preformed at Benha university hospital and King Fahd general hospital from March 1999 to September 2001. Twenty patients had surgery for clot evacuation through open craniotomy and fifteen received medical management. Inclusion criteria were Glasgow Coma Score> 5 at the time of enrollment, with focal neurological deficits, ICH volume> 20 cc on the initial brain CT scan. The follow up period was three months. Outcome was defined using the Glasgow Outcome Scale [GOS]. A good outcome was defined as GOS score> 3 at 3 months. Overall the results of management of spontaneous supratentorial ICH either by surgical or medical treatment is potentially confounded and inconclusive. Fourty six percent of the patients died [GOS 1], 34% remained severely disabled [GOS 3] and 20% became independent with moderate disability [GOS 4]. The likelihood of a good outcome [GOS >3] for the surgical treatment group differ from the medical treatment group [25% vs 13%]. There was no significant difference in mortality at 3 months [45% vs. 46.6%]. At the end of the follow up period, the median GOS score showed a nonsignificant trend towards a better outcome in the surgical treatment group against the medical treatment group [56% vs. 53%]. Craniotomy with clot evacuation for spontaneous supratentorial ICH may result in functional independence in approximately a quarter of patients [5 out 20]. Despite this, there is no clear indication from this study for the optimal treatment of these patients either through aggressive surgical intervention or conservative medical management

Increased intraocular pressure: a sequala of prone positioning of anesthetized patients during spine surgery

The study was designed to evaluate the effects of changing patient's position on intraocular pressure [IOP] during spine surgery, and to study the effect of Preoperative diuretic injection. The study comprised 45 ASA grade I and II, patients assigned to undergo spine surgery under general anesthesia. Patients were divided into three equal groups: group I and II assigned to undergo surgery in prone position, but group I received intravenous mannitol 0.5gr. / kg, 1/2 an hour before induction of anesthesia, and group III assigned to undergo surgery in lateral position. [IOP[B]] was measured before premedication. [IOP[1]] after induction in the supine position. [IOP[2]] 1/2 hr. after position change. [IOP[3]] at the end of surgery before position change. [IOP[4]] before emergence from anesthesia, but after return to supine position. At each estimation of IOP, mean arterial pressure [MAP] and heart rate [HR] were recorded. The length of time in prone position was measured. Transposition from supine resulted in significant [P<0.05] hemodynamic changes in prone position and non-significant [P>0.05] in lateral position. IOP[2] was significantly [P<0.05] higher compared both to IOP[B] and IOP[1], but, transfer to lateral position, despite resulting in increased IOP compared to their IOP[B] and IOP[1], induced a significantly [P<0.05] decrease of IOP compared to groups I and II. IOP still progressively increased in group II with a significant [P<0.05] difference compared to the other two groups, maintenance of lateral position resulted in progressively decreased IOP. Return to supine position resulted in decreased IOP in the three groups, but more pronounced in groups I and There was a positive significant correlation between the duration in prone position and IOP during such period both in group I [r=0.537, P=0.039] and in group II [r=0.719, P=0.003]. No cases of visual affection during postoperative period were detected. We could identify a relation between patient's position during spine surgery and IOP changes whether attributed to direct extraocular pressure or to induced hemodynamic imbalance, and could afford a possible prophylactic measure to attenuate the rise of lop by change the patient position to the lateral position or use of mannitol prior to induction of anesthesia