RESUMO
BACKGROUND: The risk and benefits of early neurosurgical intervention in patients with non-traumatic intracerebral hematoma (NICH) are still unclear. OBJECTIVE: To evaluate an effectiveness of early surgery in patients with NICH compared to primary conservative therapy. MATERIAL AND METHODS: There were 115 patients with indications for surgery. The indications were supratentorial NICH over 30 cm3 and GCS score >7 points. All patients were divided into 2 groups: the main group (n=59) - NICH removal within 24 hours; the control group (n=56) - conservative treatment only. Both groups were comparable by the main clinical, demographic and neuroimaging characteristics. We analyzed survival rates and functional status using Glasgow outcome scale extended (GOSE) 6 months later. RESULTS: Median survival in the main group was 71 days vs. 11 days in the control group (p<0.05); cumulative 6-month survival - 46% and 34%, respectively (p>0.05). Surgical treatment resulted higher number of patients with severe (13% vs. 5%) and moderate disability (29% vs. 23%). There were 2% of patients with good recovery in the group of surgical treatment and 4% of patients after conservative management. However, between-group differences were not significant (p>0.05). CONCLUSION: Early surgical evacuation of non-traumatic intracerebral hematoma is accompanied by less early postoperative mortality. There were no significant between-group differences in functional outcomes and survival rates after 6 months.
