The Role of Risk Factor in the Surgical Treatment of Hemorrhagic Stroke

Abstract

AIM OF STUDY To identify risk factors for adverse outcomes of surgical treatment of patients with HS.MATERIAL AND METHODS A retrospective analysis of the results of surgical treatment of 500 patients operated on at the N.V. Sklifosovsky Institute from 1997 to 2020 for hypertensive intracerebral hematomas. The mean age of the patients was 53.1±12.2 years. There were 335 (67%) men and 165 (33%) women.The level of consciousness before the operation was clear in 176 (35.2%), stupor (11–14 score, GCS) — in 258 (53.6%), sopor (score 9–10, GCS) — in 38 (7.6 %), moderate coma (7–8 score, GCS) — in 10 (2%) patients, deep coma (score 6) — in 7 (1.4%) patients. ICHs were lobar in 218 (43.6%) patients, lateral in 212 (42.4%) patients, thalamic in 10 (2%) patients, mixed in 10 (2%) patients, cerebellar in 50 (10% ) patients. The average volume of ICH was 46.5±25.1 cm3, supratentorial ICH – 49.6±24.5 cm3 (from 4 to 147 cm3), subtentorial — 18.7±6.4 cm3 (from 5 to 36 cm3). The average duration of the surgical intervention was 3.3±2.6 days. The following types of operations were performed: open removal of the ICH in 271 (54.2%) patients, puncture aspiration and local fibrinolysis of the ICH in 98 (19.6%) cases, endoscopic aspiration of the ICG in 131 (26.2%) patients.RESULTS The risk factors for lethal outcome in HT surgery are the age of patients older than 50 years (χ2=13.9, p<0.04), the volume of cerebral hemispheres more than 50 cm3 (χ2=7.8, p<0.01), the total volume of ICH and perifocal edema more than 100 cm3 (χ2=9.1, p<0.01), transverse dislocation of the median structures of the brain more than 5 mm (χ2=32.2, p<0.0001), axial dislocation of the brain (χ2=16 ,1, p<0.02), BP before surgery higher than 160 mm Hg (χ2=21.9, p<0.002), presence of IVH (χ2=36.9, p<0.00001), AOH (χ2=28.0, p<0.0001), surgery time — the first day after hemorrhage (χ2=64.4, p<0.00001), residual volume of ICH after surgery more than 15 cm3 (χ2=4.0, p<0.05) and recurrence of ICH (χ2=33.1, p<0.00001). The outcomes correlate with the severity of the patient’s condition before surgery (R=0.38, p<0.00001), and the risk factor for death is the depression of consciousness to deep stupor and below (χ2=97.2, p<0.00001).CONCLUSION Assessment of risk factors can help clarify the prognosis of the outcomes of surgical treatment and optimize the treatment tactics of patients.

Keywords

• hemorrhagic stroke
• surgical treatment
• risk factors
• duration of surgery
• level of consciousness
• ich volume
• brain dislocation
• blood pressure
• recurrent hemorrhage
• occlusive hydrocephalus