Surgical vs medical treatment of SSICH

ABSTRACT

To study and compare the effectiveness and outcome of the surgical treatment versus medical management of patients with spontaneous supratentorial intracerebral haemorrhage [SSICH]. A comprehensive review of 35 patients with spontaneous supratentorial ICH was carried out at Banha University Hospital and King Fahd General Hospital from March 1999 to September 2001. Twenty patients had surgery for clot evacuation through open craniotomy and 15 received medical management. Inclusion criteria was Glasgow Coma Score [GCS]> 5 at the time of enrollment, with focal neurological deficits and ICH volume > 20 cc on the initial brain computed tomography scan. The follow-up period was 3 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 surgically or medically is inconclusive. Forty-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 differs 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 conservative medical treatment group [56% vs 53%]. Craniotomy with clot evacuation for spontaneous supratentorial ICH may result in functional independence in approximately 25% 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