scholarly journals Retrospective comparison of decompressive hemicraniectomy and hematoma evacuation for spontaneous supratentorial intracerebral hematoma

Pulse ◽  
2015 ◽  
Vol 7 (1) ◽  
pp. 16-21 ◽  
Author(s):  
MA Joarder ◽  
AKMB Karim ◽  
T Kamal ◽  
T Sujon ◽  
N Akhter ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Intracerebral Hematoma ◽  
Modified Rankin Scale ◽  
Hematoma Volume ◽  
Coma Scale ◽  
Decompressive Hemicraniectomy ◽  
Hematoma Evacuation ◽  
Retrospective Comparison ◽  
P 16 ◽  
Poor Outcomes

Objectives: The aim of this study was to test the hypothesis that decompressive hemicraniectomy (DHC), compared with craniotomy with evacuation of hematoma, and would improve clinical outcomes of patients with supratentorial intracerebral hemorrhage (SICH).Methods: We compared patients (November 2008–February 2014) with supratentorial ICH treated with DHC without hematoma evacuation and craniotomy with hematoma evacuation. DHC measured at least 150 mm and included opening of the dura. We analyzed clinical, radiological, and surgical characteristics. Outcome at 6 months was divided into good (modified Rankin Scale 0–4) and poor (modified Rankin Scale 5–6).Results: Fifteen patients (mean age 58 years) with ICH were treated by DHC. Median hematoma volume was 61 ml and mean preoperative Glasgow Coma Scale (GCS) was 7. Ten patients had good and five had poor outcomes. In hematoma evacuation group 29 patients were treated. Median hematoma volume was 55 ml and mean preoperative Glasgow Coma Scale (GCS) was 8. Seventeen patients had good and twelve had poor outcomes.Conclusions: DHC is more effective than hematoma evacuation in patients with SICH. Based on this small cohort, DHC may reduce mortality. Larger prospective study is warranted to assess safety and efficacy.Pulse Vol.7 January-December 2014 p.16-21

Diffusion-weighted MR Imaging in Closed Head Injury: High Correlation with Initial Glasgow Coma Scale Score and Score on Modified Rankin Scale at Discharge

Radiology ◽  
2004 ◽  
Vol 233 (1) ◽  
pp. 58-66 ◽  
Author(s):  
Pamela W. Schaefer ◽  
Thierry A. G. M. Huisman ◽  
A. Gregory Sorensen ◽  
R. Gilberto Gonzalez ◽  
Lee H. Schwamm
Keyword(s):  
Head Injury ◽  
Mr Imaging ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Closed Head Injury ◽  
Modified Rankin Scale ◽  
Coma Scale ◽  
Diffusion Weighted ◽  
Closed Head

Frontal bur hole through an eyebrow incision for image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage

2012 ◽  
Vol 117 (4) ◽  
pp. 767-773 ◽  
Author(s):  
Justin A. Dye ◽  
Joshua R. Dusick ◽  
Darrin J. Lee ◽  
Nestor R. Gonzalez ◽  
Neil A. Martin
Keyword(s):  
Glasgow Coma Scale ◽  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Invasive Technique ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Midline Shift ◽  
Hematoma Volume ◽  
Coma Scale ◽  
Endoscopic Evacuation ◽  
The Mean

Object Surgical evacuation of spontaneous intracerebral hemorrhage (sICH) remains a subject of controversy. Minimally invasive techniques for hematoma evacuation have shown a trend toward improved outcomes. The aim of the present study is to describe a minimally invasive alternative for the evacuation of sICH and evaluate its feasibility. Methods The authors reviewed records of all patients who underwent endoscopic evacuation of an sICH at the UCLA Medical Center between March 2002 and March 2011. All patients in whom the described technique was used for evacuation of an sICH were included in this series. In this approach an incision is made at the superior margin of the eyebrow, and a bur hole is made in the supraorbital bone lateral to the frontal sinus. Using stereotactic guidance, the surgeon advanced the endoscopic sheath along the long axis of the hematoma and fixed it in place at two specific depths where suction was then applied until 75%–85% of the preoperatively determined hematoma volume was removed. An endoscope's camera, then introduced through the sheath, was used to assist in hemostasis. Preoperative and postoperative hematoma volumes and reduction in midline shift were calculated and recorded. Admission Glasgow Coma Scale and modified Rankin Scale (mRS) scores were compared with postoperative scores. Results Six patients underwent evacuation of an sICH using the eyebrow/bur hole technique. The mean preoperative hematoma volume was 68.9 ml (range 30.2–153.9 ml), whereas the mean postoperative residual hematoma volume was 11.9 ml (range 5.1–24.1 ml) (p = 0.02). The mean percentage of hematoma evacuated was 79.2% (range 49%–92.7%). The mean reduction in midline shift was 57.8% (p < 0.01). The Glasgow Coma Scale score improved in each patient between admission and discharge examination. In 5 of the 6 patients the mRS score improved from admission exam to last follow-up. None of the patients experienced rebleeding. Conclusions This minimally invasive technique is a feasible alternative to other means of evacuating sICHs. It is intended for anterior basal ganglia hematomas, which usually have an elongated, ovoid shape. The approach allows for an optimal trajectory to the long axis of the hematoma, making it possible to evacuate the vast majority of the clot with only one pass of the endoscopic sheath, theoretically minimizing the amount of damage to normal brain.

SUBARACHNOID HEMORRHAGE AND INTRACEREBRAL HEMATOMA

Neurosurgery ◽  
2008 ◽  
Vol 63 (6) ◽  
pp. 1088-1094 ◽  
Author(s):  
Erdem Güresir ◽  
Jürgen Beck ◽  
Hartmut Vatter ◽  
Matthias Setzer ◽  
Rüdiger Gerlach ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Odds Ratio ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Favorable Outcome ◽  
Intracerebral Hematoma ◽  
Modified Rankin Scale ◽  
Poor Grade ◽  
Hematoma Evacuation ◽  
Number Of Patients ◽  
Good Grade

Abstract OBJECTIVE To analyze the incidence and impact of an intracerebral hematoma (ICH) on treatment and outcome in patients with aneurysmal subarachnoid hemorrhage. METHODS Data of 585 consecutive patients with subarachnoid hemorrhage from June 1999 to December 2005 were prospectively entered in a database. ICH was diagnosed and size was measured by computed tomographic scan before aneurysm occlusion. Fifty patients (8.5%) presented with an ICH larger than 50 cm3. The treatment decision (coil, clip, or hematoma evacuation) was based on an interdisciplinary approach. Patients were stratified into good (Hunt and Hess Grades I–III) versus poor (Hunt and Hess Grades IV and V) grade, and outcome was assessed according to the modified Rankin Scale at 6 months. RESULTS Overall, 358 patients presented in good grade, with 4 of them having ICH (1.1%); and 227 patients presented in poor grade, with 46 of them having ICH (20.3%, P &lt; 0.01). In good-grade patients with an ICH (n = 4), a favorable outcome (modified Rankin Scale score of 0–2) was achieved in 1 patient (25%), and in 246 patients (75%) without an ICH (P = 0.053; odds ratio, 0.11). A favorable outcome was achieved in 5 poor-grade patients (12.8%) with an ICH and in 40 patients (23.7%) without an ICH (P = 0.19; odds ratio, 0.47). Time to treatment was significantly shorter in patients with an ICH than without an ICH (median, 7 versus 26 h; P &lt; 0.001) and shortest in patients with favorable outcome (3.5 hours; P &lt; 0.01). CONCLUSION The current data confirm that the presence of an ICH is a predictor of unfavorable outcome. However, despite large ICHs, a significant number of patients have a good outcome. To achieve a favorable outcome, ultra-early treatment with hematoma evacuation and aneurysm obliteration seems to be mandatory.

scholarly journals Technical Notes and Result of Stereotactic Evacuation of Hematoma in Spontaneous Supratentorial Intracerebral Hematoma

2018 ◽  
Vol 15 (3) ◽  
pp. 27-31
Author(s):  
Resha Shrestha ◽  
Pranaya Shrestha ◽  
Pravesh Rajbhandari ◽  
Samir Acharya ◽  
Sudan Dhakal ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Surgical Treatment ◽  
Minimal Invasive ◽  
Technical Note ◽  
Stereotactic Surgery ◽  
Intracerebral Hematoma ◽  
Modified Rankin Scale ◽  
Hematoma Volume ◽  
Baseline Characteristics

Primary intracerebral hematoma constitutes about 10-15% of all strokes and is associated with high mortality and severe disability. Surgical treatment of intracerebral hemorrhage is quite controversial. It is believed that minimal invasive stereotactic surgery may reduce hematoma volume and decrease secondary neurotoxicity. The technical note of stereotactic surgery has been illustrated. A retrospective study from March 2016 to March 2018 has been conducted and all patients who underwent stereotactic evacuation of hematoma were included in this study. Baseline characteristics of patients and outcome in terms of Glasgow Coma Scale (GCS) and Modified Rankin Scale (mRS) have been shown. We have found significant improvement in GCS postoperatively, however mRS did not improve immediately but was significantly better in three months follow up period.

Glasgow Coma Scale and hematoma volume as criteria for treatment of putaminal and thalamic intracerebral hemorrhage

2008 ◽  
Vol 70 (6) ◽  
pp. 628-633 ◽  
Author(s):  
Der-Yang Cho ◽  
Chun-Chung Chen ◽  
Han-Chung Lee ◽  
Wen-Yuan Lee ◽  
Hong-Lin Lin
Keyword(s):  
Glasgow Coma Scale ◽  
Intracerebral Hemorrhage ◽  
Hematoma Volume ◽  
Coma Scale

The Relationship Between Serum Neuron-Specific Enolase Levels and Severity of Bleeding and Functional Outcomes in Patients With Nontraumatic Subarachnoid Hemorrhage

Neurosurgery ◽  
2015 ◽  
Vol 78 (4) ◽  
pp. 487-491 ◽  
Author(s):  
Rabih G. Tawk ◽  
Sanjeet S. Grewal ◽  
Michael G. Heckman ◽  
Bhupendra Rawal ◽  
David A. Miller ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Functional Outcomes ◽  
Multivariable Analysis ◽  
Neuron Specific Enolase ◽  
World Federation ◽  
Modified Rankin Scale ◽  
Coma Scale ◽  
Fisher Grade

Abstract BACKGROUND: The value of neuron-specific enolase (NSE) in predicting clinical outcomes has been investigated in a variety of neurological disorders. OBJECTIVE: To investigate the associations of serum NSE with severity of bleeding and functional outcomes in patients with subarachnoid hemorrhage (SAH). METHODS: We retrospectively reviewed the records of patients with SAH from June 2008 to June 2012. The severity of SAH bleeding at admission was measured radiographically with the Fisher scale and clinically with the Glasgow Coma Scale, Hunt and Hess grade, and World Federation of Neurologic Surgeons scale. Outcomes were assessed with the modified Rankin Scale at discharge. RESULTS: We identified 309 patients with nontraumatic SAH, and 71 had NSE testing. Median age was 54 years (range, 23-87 years), and 44% were male. In multivariable analysis, increased NSE was associated with a poorer Hunt and Hess grade (P = .003), World Federation of Neurologic Surgeons scale score (P &lt; .001), and Glasgow Coma Scale score (P = .003) and worse outcomes (modified Rankin Scale at discharge; P = .001). There was no significant association between NSE level and Fisher grade (P = .81) in multivariable analysis. CONCLUSION: We found a significant association between higher NSE levels and poorer clinical presentations and worse outcomes. Although it is still early for any relevant clinical conclusions, our results suggest that NSE holds promise as a tool for screening patients at increased risk of poor outcomes after SAH.

scholarly journals Hematoma Shape, Hematoma Size, Glasgow Coma Scale Score and ICH Score: Which Predicts the 30-Day Mortality Better for Intracerebral Hematoma?

PLoS ONE ◽  
2014 ◽  
Vol 9 (7) ◽  
pp. e102326 ◽  
Author(s):  
Chih-Wei Wang ◽  
Yi-Jui Liu ◽  
Yi-Hsiung Lee ◽  
Dueng-Yuan Hueng ◽  
Hueng-Chuen Fan ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Intracerebral Hematoma ◽  
Coma Scale ◽  
Ich Score

scholarly journals Hubungan ICH Score dengan Outcome Fungsional (Setelah 3 Bulan)

2018 ◽  
Vol 7 ◽  
pp. 21
Author(s):  
Fanel Putra ◽  
Meiti Frida ◽  
Basjiruddin Ahmad
Keyword(s):  
Glasgow Coma Scale ◽  
Ct Scan ◽  
Modified Rankin Scale ◽  
Coma Scale ◽  
Brain Ct ◽  
Brain Ct Scan ◽  
Ich Score

Latar Belakang: ICH score adalah skala penilaian klinis yang umum digunakan dalam menentukan outcome setelah perdarahan intraserebral akut (PIS) dan telah divalidasi untuk memprediksi kematian setelah 30 hari, tetapi tidak untuk outcome fungsional jangka panjang.Tujuan Penelitian: Tujuan dari penelitian ini adalah untuk menilai apakah ICH score bisa digunakan dalam menilai outcome fungsional selama 3 bulan dan untuk menggambarkan kecepatan pemulihan pasien setelah PIS pada 3 bulan pertama.Metode: Kami melakukan penelitian kohort prospektif observasional dari semua pasien PIS dengan PIS akut yang diterima IGD Rumah Sakit Umum Pusat Dr. M. Djamil Padang dan sudah dilakukan Brain CT Scan tanpa kontras dari tanggal 1 Juni 2014 hingga 20 Juli 2014. Komponen ICH score (skor Glasgow Coma Scale pada saat masuk, volume hematoma awal, adanya perdarahan intra ventrikel, perdarahan infratentorial dan usia) dicatat bersama dengan karakteristik klinis lainnya. Pasien kemudian dinilai dengan modified Rankin Scale (mRS) saat pulang dari rumah sakit, 30 hari serta 2 dan 3 bulan setelah keluar dari rumah sakit.Hasil: Dari 26 pasien, 11 (42%) pasien meninggal selama perawatan di rumah sakit pada awal fase akut. ICH score bisa digunakan dalam menilai outcome fungsional (mRS) selama 3 bulan (p<0,05) dengan menggunakan uji korelasi Spearman (SPSS 15). Beberapa pasien menunjukkan perbaikan pada 3 bulan pertama, dengan sejumlah kecil pasien menjadi cacat atau mati karena komplikasi yang tidak berhubungan dengan PIS akut.Kesimpulan: ICH score adalah skala penilaian klinis yang bisa digunakan untuk menilai outcome fungsional jangka panjang setelah PIS. Beberapa pasien PIS membaik setelah keluar rumah sakit dan perbaikan ini berlanjut sampai 3 bulan setelah keluar dari rumah sakit.

Impact of Intracerebral Hematoma Evacuation During Decompressive Hemicraniectomy on Functional Outcomes

Stroke ◽  
2021 ◽  
Author(s):  
Luyuan Li ◽  
Vaelan A. Molian ◽  
Scott C. Seaman ◽  
Mario Zanaty ◽  
Matthew A. Howard ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Scale Score ◽  
Glasgow Outcome Scale ◽  
Functional Outcomes ◽  
Intracerebral Hematoma ◽  
Spontaneous Intracerebral Hemorrhage ◽  
University Of Iowa ◽  
Decompressive Hemicraniectomy ◽  
Hematoma Evacuation ◽  
The University

Background and Purpose: Decompressive hemicraniectomy has been used to treat spontaneous intracerebral hemorrhage, but the benefit of evacuating the hematoma during the procedure is unclear. We aim to evaluate the utility of performing clot evacuation during hemicraniectomy for spontaneous intracerebral hemorrhage. Methods: Retrospective cohort of consecutive patients (2010–2019) treated with decompressive hemicraniectomy for a spontaneous supratentorial intracerebral hemorrhage at the University of Iowa. We compared hemicraniectomy alone to hemicraniectomy plus hematoma evacuation. We analyzed clinical features and hematoma characteristics. The outcomes at 6 months were dichotomized into unfavorable (Glasgow Outcome Scale score 1–3) and favorable (Glasgow Outcome Scale score 4–5). Results: Eighty-three patients underwent decompressive hemicraniectomy for spontaneous intracerebral hemorrhage, 52 with hematoma evacuation, and 31 without hematoma evacuation. There were no statistically significant differences in clinical and radiographic characteristics between the 2 groups. Evacuating the hematoma in addition to hemicraniectomy did not change the odds of favorable outcome at 6 months ( P =0.806). Conclusions: In this retrospective study, the performance of hematoma evacuation during decompressive hemicraniectomy for spontaneous intracerebral hemorrhage may not change functional outcomes over performing the hemicraniectomy alone.

Abstract TP137: Increased Survival of Malignant Middle Cerebral Artery Stroke Patients with Midline Shift and High Glasgow Coma Scale Undergoing Decompressive Hemicraniectomy

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Chris Ojeda ◽  
Nitya Chitravanshi ◽  
Patrick C Reid ◽  
Ennis J Duffis ◽  
Charles J Prestigiacomo ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Survival Rate ◽  
Glasgow Coma Scale ◽  
Medical Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Midline Shift ◽  
Coma Scale ◽  
Decompressive Hemicraniectomy ◽  
Neurological Surgery

Intro: Ischemic stroke of the middle cerebral artery often results in malignant cerebral edema leading to rapid clinical decline and midline shift. Decompressive hemicraniectomy (DHC) has been shown to improve clinical outcome in cases of malignant infarct but indications of when to perform it have not been well classified. This study focuses on patients who suffered malignant middle cerebral artery (MMCA) infarct and entered with mild brain injury (initial Glasgow Coma Scale≥13). Survival rates were compared among patients who received DHC versus medical treatment with a focus on midline shift. Hypothesis: Patients entering for MMCA with a Glascow Coma Scale ≥13who develop midline shift will have reduced mortality due to DHC relative to those with an entirely medical treatment. Methods: Retrospective review was performed on all cases consulted for neurological surgery from 2007-2012 at University Hospital. Patients were selected on the criteria of MMCA infarct. Midline shifts used were recorded prior to surgery or in the absence of surgery, 2-4 days post infarct. The primary endpoint was mortality at discharge. Multiple regression analysis was performed comparing the patient outcome to the degree of midline shift and if DHC occurred. Results: In total, 91 patients were referred to neurological surgery and 34 qualified with an initial Glasgow Coma Scale ≥13. Of those, 10 received a DHC, all with a midline shift and a survival rate of 70% (7/10). Exclusively medical treatment was done on 24 patients, 7 had midline shift reported with a survival rate of 29% (2/7) and 17 with no shift had a survival rate of 100% (17/17).The total medical survival rate was 79% (19/24). Regression analysis showed statistical significance (p<0.05) with mortality as the dependent variable and degree of midline shift (mm) and if DHC occurred as independent variables with GraphPad InStat 3.10. Conclusion: A statistically significant increase in survival has been found with use of DHC for MMCA infarct patients with a high Glasgow Coma Scale who have midline shift.

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