Comparing the results of surgical and conservative treatment of patients with supratentorial hypertensive intracerebral hemorrhage. A new look at previously known randomized studies

Abstract

Hemorrhagic stroke is a medical and social problem, with an incidence of 1535 per 100 000 people per year. It is characterized by high patient mortality (up to 53% in the first year) and disability, with most of the surviving patients having persistent neurological deficits and about 20% of them requiring continuous assistance. The advantages of surgical or conservative treatment of patients with supratentorial hypertensive intracerebral hemorrhage (ICH) are still under discussion. This literature review is based on 12 open-source articles on prospective randomized trials comparing conservative and surgical treatment results in patients with supratentorial ICH, which demonstrate contradictory results. Based on an analysis of all the works, we can conclude that surgical treatment has an advantage when performed early (within 1272 hours) in patients whose level of consciousness is 912 points on the Glasgow Coma Scale. Needle aspiration and local fibrinolysis are effective for basal ganglia ICH, while open surgery and endoscopic aspiration are effective in subcortical ICH. For subcortical ICHs that are 2080 cm3 in size, surgical treatment improved functional outcomes, while in ICHs larger than 50 cm3, it helped to reduce mortality.

Keywords

• hemorrhagic stroke
• supratentorial intracerebral hemorrhage prospective studies
• randomized studies
• surgical treatment
• conservative treatment