Correlation of the long-term neurological outcomes with completeness of surgical evacuation in spontaneous supratentorial intracerebral haemorrhage: a retrospective study

Choy DKS, Wu PH, Tan D, Yeo TT, Chou N
Correspondence: Dr David Choy Kim Seng, cfschoyd@nus.edu.sg

ABSTRACT
Introduction The treatment of primary spontaneous supratentorial intracerebral haemorrhage (ICH) by evacuation is not supported by randomised controlled trials. We investigate the effectiveness of the completeness of surgical evacuation of spontaneous supratentorial ICH with respect to the functional neurological outcome and mortality.
Methods A retrospective review of patients who underwent supratentorial ICH evacuations in the Neurosurgical Unit of the National University Hospital, Singapore, between January 2002 and December 2005 was conducted. Preoperative and postoperative computed tomography images were compared, and the patients or their family members completed follow-up questionnaires two years post surgery, in order to assess the neurological outcome.
Results The patients were subdivided into two groups based on the Glasgow Outcome Scale and haematoma volume. Patients with small pre-evacuation haematoma had a median percentage change in volume and a midline shift of 97.63 percent and 63 percent, respectively. Patients with a large haematoma volume had a median percentage change in volume and midline shift of 99.54 percent and 100 percent, respectively (the p-values for percentage change in volume and midline shift are 0.764 and 0.742, respectively). The median percentage change in volume for the poor outcome subgroup was 97.63 percent, compared to 100 percent for the good outcome subgroup (p-value is 0.288). The median change in midline shift in the poor and good outcome subgroups was 63 percent and 100 percent, respectively (p-value is 0.576).
Conclusion Although not statistically significant with regard to the completeness of haematoma evacuation, a trend toward better outcome with more complete evacuation is observed with ICH.

Keywords: Glasgow Outcome Scale, spontaneous intracerebral haemorrhage, surgical evacuation
Singapore Med J 2010; 51(4): 320-325