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摘要
Background and Purpose: The role of surgery after primary intracerebral hemorrhage (ICH) is controversial. To explore whether hematoma evacuation after ICH had improved short-term survival or functional outcome we conducted a retrospective observational population-based study. %26lt;br%26gt;Methods: We identified all subjects with primary ICH between 1993 and 2008 among the population of Northern Ostrobothnia, Finland. Hematoma evacuation was carried out by using standard craniotomy or through a burr hole. We compared mortality rates and functional outcomes of patients with hematoma evacuation with those treated conservatively. %26lt;br%26gt;Results: Of 982 patients with verified ICH during the study period, 127 (13%) underwent hematoma evacuation. Surgically treated patients were significantly younger (mean +/- SD, 63 +/- 11 vs. 70 +/- 12 years; p %26lt; 0.001), had larger hematomas (66 +/- 36 vs. 28 +/- 40 ml; p %26lt; 0.001), lower Glasgow Coma Scale scores (median, 11 vs. 14; p %26lt; 0.001) and more frequently subcortical hematomas (68% vs. 24%; p %26lt; 0.001) than those treated conservatively. In multivariable analysis, hematoma evacuation independently lowered 3-month mortality (adjusted hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.43-0.88; p %26lt; 0.03), particularly among patients aged %26lt;= 70 years with %26gt;= 30 ml supratentorial hematomas (adjusted HR, 0.26; 95% CI, 0.14-0.49; p %26lt; 0.001). However, poor outcome was not improved by surgery (adjusted odds ratio 0.71; 95% CI 0.29-1.70). %26lt;br%26gt;Conclusions: Improved 3-month survival was observed in patients who had undergone hematoma evacuation relative to patients not undergoing evacuation particularly in the subgroup of patients aged %26lt;= 70 years with %26gt;= 30 ml supratentorial hematomas. Surgery might improve outcome if cases could be selected more precisely and if performed before deterioration.
- 出版日期2013-8
