Early surgical treatment for supratentorial intracerebral hemorrhage: A randomized feasibility study

Mario Zuccarello, Thomas Brott, Laurent Derex, Rashmi Kothari, Laura Sauerbeck, John Tew, Harry Van Loveren, Hwa Shain Yeh, Thomas Tomsick, Arthur Pancioli, Jane Khoury, Joseph Broderick

Research output: Contribution to journalArticle

242 Scopus citations

Abstract

Background and Purpose - The safety and the effectiveness of the surgical treatment of spontaneous intracerebral hemorrhage (ICH) remain controversial. To investigate the feasibility of urgent surgical evacuation of ICH, we conducted a small, randomized feasibility study of early surgical treatment versus current nonoperative management in patients with spontaneous supratentorial ICH. Methods - Patients with spontaneous supratentorial ICH who presented to 1 university and 2 community hospitals were randomized to surgical treatment or best medical treatment. Principal eligibility criteria were ICH volume >10 cm3 on baseline CT scan with a focal neurological deficit, Glasgow Coma Scale score >4 at the time of enrollment, randomization and therapy within 24 hours of symptom onset, surgery within 3 hours of randomization, and no evidence for ruptured aneurysm or arteriovenous malformation. The primary end point was the 3-month Glasgow Outcome Scale (GOS). A good outcome was defined as a 3-month GOS score >3. Results - Twenty patients were randomized over 24 months, 9 to surgical intervention and 11 to medical treatment. The median time from onset of symptoms to presentation at the treating hospitals was 3 hours and 17 minutes, the time from randomization to surgery was 1 hour and 20 minutes, and the time from onset of symptoms to surgery was 8 hours and 35 minutes. The likelihood of a good outcome (primary outcome measure: GOS score >3) for the surgical treatment group (56%) did not differ significantly from the medical treatment group (36%). There was no significant difference in mortality at 3 months. Analysis of the secondary 3-month outcome measures showed a nonsignificant trend toward a better outcome in the surgical treatment group versus the medical treatment group for the median GOS, Barthel Index, and Rankin Scale and a significant difference in the National Institutes of Health Stroke Scale score (4 versus 14; P=0.04). Conclusions - Very early surgical treatment for acute ICH is difficult to achieve but feasible at academic medical centers and community hospitals. The trend toward less 3-month morbidity with surgical intervention in patients with spontaneous supratentorial ICH warrants further investigation of very early clot removal in larger randomized clinical trials.

Original languageEnglish (US)
Pages (from-to)1833-1839
Number of pages7
JournalStroke
Volume30
Issue number9
DOIs
StatePublished - Sep 1999

Keywords

  • Craniotomy
  • Intracerebral hemorrhage
  • Medical management
  • Stereotaxic aspiration
  • Surgical treatment

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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    Zuccarello, M., Brott, T., Derex, L., Kothari, R., Sauerbeck, L., Tew, J., Van Loveren, H., Yeh, H. S., Tomsick, T., Pancioli, A., Khoury, J., & Broderick, J. (1999). Early surgical treatment for supratentorial intracerebral hemorrhage: A randomized feasibility study. Stroke, 30(9), 1833-1839. https://doi.org/10.1161/01.STR.30.9.1833