Medical versus neurosurgical treatment in ICH patients: a single center experience

Background and aimsThe effect of surgical treatment for spontaneous intracerebral hemorrhage (ICH) remains uncertain. We conducted an observational retrospective cohort study on supra-centimeter spontaneous ICH treated with either neurosurgical or conservative management. The baseline demographics and risk factors were correlated with in-hospital mortality and 3 and 6-month survival rates stratified by management.MethodsWe included all patients with evidence of spontaneous ICH > 1 cm detected by CT and admitted between august 2020 and march 2021 to the SMM Hospital in Perugia.ResultsOnehundredandtwentytwo patients were included in the study, and 45% (n.55) were surgically treated. The mean age was 71.9 & PLUSMN; 15.3, and 61% (n.75) were males. Intra-hospital mortality ended up being 31% (n.38), 3 months-survival was 63% (n.77) and 6 months-survival was 60% (n.73).From the multivariate analysis of the surgical patients versus medical patient, we observed that the surgical patients were younger (67.5 & PLUSMN; 14.9 vs 75.5 & PLUSMN; 14.7 y; OR 0.87; Cl 95% 0.85-0.94; p 0.001), with greater ICH volume at the onset (61 & PLUSMN; 39.4 cc vs 51 & PLUSMN; 64 cc; OR 1.03; Cl 95% 1.005-1.07; p 0.05), more midline shift (7.61 & PLUSMN; 5.54 mm vs 4.09 & PLUSMN; 5.88 mm; OR 1.37; Cl 95% 1.045-1.79; p 0.023), and a higher ICH score (3 vs 2 mean ICH score; OR 21.12; Cl 95% 2.6-170.6; p 0.004). Intra-hospital mortality in the surgical group and in the conservative treatment group was respectively 33% vs 30%, 3 month-survival was 64% vs 63% and 6 month- survival were 60% in both groups.ConclusionsOur patient cohort shows no overall benefit from surgery over conservative treatment, but surgical patients were younger and had larger ICH volume.

Automated summary

This study compared surgical and conservative treatment for patients with spontaneous intracerebral hemorrhage (ICH) and found that surgical patients were younger and had larger ICH volume, but overall there was no significant benefit from surgery.