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Surgery for primary supratentorial intracerebral haemorrhage

Published on Oct 8, 2008in Cochrane Database of Systematic Reviews7.755
· DOI :10.1002/14651858.CD000200.PUB2
Kameshwar Prasad30
Estimated H-index: 30
(AIIMS: All India Institute of Medical Sciences),
A. David Mendelow30
Estimated H-index: 30
,
Barbara A. Gregson31
Estimated H-index: 31
Abstract
BACKGROUND:There is considerable international variation in the rate and indications of surgery for primary supratentorial intracerebral haematoma, reflecting the uncertainty about the effects of surgery. Recently, some large randomised trials have appeared in the literature but the controversy over its role continues. This is an update of a Cochrane review first published in 1997, and previously updated in 1999. OBJECTIVES:To assess the effects of surgery plus routine medical management, compared with routine medical management alone, in patients with primary supratentorial intracerebral haematoma. SEARCH STRATEGY:We searched the Cochrane Stroke Group Trials Register (last searched June 2007), checked reference lists of relevant articles and contacted authors of relevant trials. In addition, for the original version of this review we handsearched two journals, Current Opinion in Neurology and Neurosurgery, and Neurosurgical Clinics of North America (1991 to July 1993), and three monographs. We contacted study authors for relevant information. SELECTION CRITERIA:Randomised trials of routine medical treatment plus intracranial surgery compared with routine medical treatment alone in patients with CT-confirmed primary supratentorial intracerebral haematoma. Intracranial surgery included craniotomy, stereotactic endoscopic evacuation or stereotactic aspiration. DATA COLLECTION AND ANALYSIS:Two review authors independently applied the inclusion criteria, assessed trial quality and extracted the data. MAIN RESULTS:Ten trials with 2059 participants were included. The quality of most of the trials was acceptable but not high. Because of this and as the overall result was sensitive to the losses to follow up in the largest trial, the estimates of effect may not be robust and may be subject to bias. Surgery was associated with statistically significant reduction in the odds of being dead or dependent at final follow up (odds ratio (OR) 0.71, 95% confidence interval (CI) 0.58 to 0.88; 2P = 0.001) with no significant heterogeneity among the study results. Surgery was also associated with significant reduction in the odds of death at final follow up (OR 0.74, 95% CI 0.61 to 0.90; 2P = 0.003); however, there was significant heterogeneity for death as outcome. AUTHORS' CONCLUSIONS:In patients with CT-proven primary supratentorial intracerebral haemorrhage, surgery added to medical management reduces the odds of being dead or dependent compared with medical management alone, but the result is not very robust. Hence, further randomised trials to identify which patients benefit from surgery and to evaluate less invasive methods are indicated.
  • References (33)
  • Citations (108)
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References33
Newest
#1Kristine M. Thompson (Mayo Clinic)H-Index: 9
#2Sharon Y. Gerlach (Mayo Clinic)H-Index: 2
Last. Julia A. Files (Mayo Clinic)H-Index: 15
view all 6 authors...
Intracerebral hemorrhage (ICH), which comprises 15% to 30% of all strokes, has an estimated incidence of 37,000 cases per year. One third of patients are actively bleeding when they present to the emergency department, and hematoma growth during the first hours after ICH onset is thought to be a prime determinant of clinical deterioration. Inflammation, as opposed to ischemia, also negatively affects patient condition. Recombinant activated factor VII is emerging as a potential first-line therap...
14 CitationsSource
#1A. David Mendelow (Newcastle University)H-Index: 30
#2Barbara A. GregsonH-Index: 31
Last. David BarerH-Index: 20
view all 9 authors...
Methods A parallel-group trial design was used. Early surgery combined haematoma evacuation (within 24 h of randomisation) with medical treatment. Initial conservative treatment used medical treatment, although later evacuation was allowed if necessary. We used the eight-point Glasgow outcome scale obtained by postal questionnaires sent directly to patients at 6 months follow-up as the primary outcome measure. We divided the patients into good and poor prognosis groups on the basis of their clin...
1,012 CitationsSource
#1Naoyuki HattoriH-Index: 5
#2Yoichi KatayamaH-Index: 54
Last. Alexander GathererH-Index: 2
view all 4 authors...
Object. Stereotactic evacuation of hematoma has been reported to reduce the incidence of mortality and to improve functional outcome in patients with spontaneous putaminal hemorrhage. Stereotactic evacuation of hematoma has not been widely accepted as a standard therapy, however, because its effect on functional outcome has been regarded as marginal and there have been no randomized trials with sufficient statistical power to quantify the benefits of this procedure. The authors reassessed the va...
79 CitationsSource
#1Barbara A. Gregson (Newcastle University)H-Index: 31
#2A. David Mendelow (Newcastle University)H-Index: 30
Background and Purpose— Spontaneous intracerebral hemorrhage is a major cause of death and disability, yet there is no convincing evidence of the benefit of any medical treatment and the role of surgery remains controversial. The international randomized Surgical Trial in Intracerebral Hemorrhage (STICH) provided an opportunity to assess the role of surgery within the centers taking part. Methods— Screening logs were completed to record details of all patients assessed by the department, whether...
53 CitationsSource
#2Simon G. ThompsonH-Index: 102
Last. Douglas G. AltmanH-Index: 209
view all 4 authors...
Cochrane Reviews have recently started including the quantity I 2 to help readers assess the consistency of the results of studies in meta-analyses. What does this new quantity mean, and why is assessment of heterogeneity so important to clinical practice? Systematic reviews and meta-analyses can provide convincing and reliable evidence relevant to many aspects of medicine and health care.1 Their value is especially clear when the results of the studies they include show clinically important eff...
24.8k CitationsSource
#1O.P.M. TeernstraH-Index: 1
#2Stefan EversH-Index: 57
Last. Gerhard BlaauwH-Index: 3
view all 6 authors...
Background and Purpose— Treatment of intracerebral hematoma (ICH) is controversial. An advantage of neurosurgical intervention over conservative treatment of ICH has not been established. Recent reports suggest a favorable effect of stereotactic blood clot removal after liquefaction by means of a plasminogen activator. The SICHPA trial was aimed at investigating the efficacy of this treatment. Methods— A stereotactically placed catheter was used to instill urokinase to liquefy and drain the ICH ...
227 CitationsSource
#1S.H TanH-Index: 1
#2P.Y NgH-Index: 1
Last. N VenketasubramanianH-Index: 1
view all 6 authors...
Abstract BACKGROUND The optimal treatment of hypertensive supratentorial intracerebral hemorrhage is still debated. Some studies have shown no improvement in survival or functional outcome after surgery when compared to conservative management while others have shown otherwise. METHODS This study was a prospective trial, matching patients for hematoma volume and Glasgow Coma score on admission. RESULTS There were a total of 34 patients. Seventeen were treated conservatively and 17 surgically. Th...
51 CitationsSource
#1Mario ZuccarelloH-Index: 44
#2Thomas G. BrottH-Index: 61
Last. Joseph P. Broderick (UC: University of Cincinnati)H-Index: 112
view all 12 authors...
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 ...
242 CitationsSource
#1Lewis B. Morgenstern (University of Texas at Austin)H-Index: 60
#2Ralph F. Frankowski (University of Texas Health Science Center at Houston)H-Index: 35
Last. James C. Grotta (University of Texas Health Science Center at Houston)H-Index: 64
view all 5 authors...
Objective: To perform a single-center pilot investigation of early hematoma removal in patients with intracerebral hemorrhage (ICH). Background: Considerable debate remains regarding the utility of surgical clot evacuation for ICH. Methods: This was a prospective trial of open craniotomy within 12 hours of ICH symptom onset versus best medical therapy. Patients were eligible if they had a nontraumatic ICH >9 mL with significant neurologic impairment and were prepared for surgery within 12 hours ...
236 CitationsSource
: Blood brain cell contact activates lipid peroxidation and arachidonic acid metabolism as shown in animal experiments. Previous studies in tumor patients have shown that enhanced cysteinyl-leukotriene (cys-LT) formation leads to increasing perifocal edema. This suggests their involvement in CNS pathology. The purpose of this study is to measure the amounts of cys-LT released during blood-brain cell contact in patients with spontaneous intracerebral hemorrhage (ICH). Seventeen patients were divi...
1 Citations
Cited By108
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#1Leonardo Lorente (Hospital Universitario de Canarias)H-Index: 33
#2María M. MartínH-Index: 16
Last. Alejandro Jiménez (Hospital Universitario de Canarias)H-Index: 29
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BACKGROUND Apoptotic cell death leads to secondary brain injury after spontaneous intracerebral hemorrhage (SIH). There is an association between serum caspase-3 levels and late mortality (at 6 months) in patients with SIH in basal ganglia. The new objective of this study was to determine whether there exists an association between serum caspase-3 levels and early mortality (at 30 days) in patients with SIH at different sites and not only in basal ganglia. METHODS Patients with severe supratento...
Source
#1Ai-Shun Guo (Fujian Medical University)
#2Guo-Shi Lin (Fujian Medical University)
Last. Rui-Sheng Lin (Fujian Medical University)
view all 9 authors...
Background Basal ganglia hemorrhage (BGH) is a devastating neurologic disease with high morbidity and mortality, and its management is still controversial. We evaluated the effectiveness of surgical treatments for BGH and investigated computed tomography (CT) imaging features affecting the hematoma evacuation rate (ER) in patients treated with neuroendoscopic surgery. Materials and Methods A total of 104 BGH patients who underwent craniotomy, burr-hole drainage, or neuroendoscopic surgery were a...
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#1Andreas Fahlström (Uppsala University Hospital)H-Index: 1
#2Henrietta Nittby Redebrandt (Lund University)H-Index: 2
Last. Niklas Marklund (Lund University)H-Index: 34
view all 12 authors...
OBJECTIVEThe authors aimed to develop the first clinical grading scale for patients with surgically treated spontaneous supratentorial intracerebral hemorrhage (ICH).METHODSA nationwide multicenter ...
Source
#1Sabino Luzzi (University of Bari)H-Index: 6
#2Angela Elia (UNIPV: University of Pavia)H-Index: 2
Last. Renato Galzio (UNIPV: University of Pavia)H-Index: 3
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Objective To delineate the most recommendable treatment of spontaneous intracerebral hemorrhages and the indication for surgery, its timing, and the best surgical technique to be adopted case by case. Methods Based on PubMed/MEDLINE, Embase, and the Cochrane Library databases, a systematic review of the literature was performed using as keywords the terms "spontaneous intracerebral hemorrhage," "surgical management," "medical management," "supratentorial," and "infratentorial." Because of the hi...
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#1Andreas Fahlström (Uppsala University)H-Index: 1
#2Lovisa Tobieson (Linköping University)H-Index: 3
Last. Niklas MarklundH-Index: 34
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Background Supratentorial intracerebral haemorrhage (ICH) carries an excessive mortality and morbidity. Although surgical ICH treatment can be life-saving, the indications for surgery in larger cohorts of ICH patients are controversial and not well defined. We hypothesised that surgical indications vary substantially among neurosurgical centres in Sweden.
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#1Ching-Jen Chen (UVA: University of Virginia)H-Index: 18
#2Dale Ding (University of Louisville)H-Index: 35
view all 8 authors...
Objective Despite no clear evidence from randomized trials, surgical intervention of spontaneous intracerebral hemorrhage (ICH) still occurs. We sought to describe the characteristics of patients undergoing surgical intervention in ICH. Methods Data from the ERICH (ERICH Ethnic/Racial Variations of Intracerebral Hemorrhage) study were analyzed, and patients with ICH were categorized into surgical intervention or nonoperative management groups. Patients with primary intraventricular hemorrhage an...
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#1Lovisa Tobieson (Linköping University)H-Index: 3
#2Bijar Ghafouri (Linköping University)H-Index: 17
Last. Niklas Marklund (Linköping University)H-Index: 34
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The secondary injury cascades exacerbating the initial brain injury following intracerebral haemorrhage (ICH) are incompletely understood. We used dual microdialysis (MD) catheters placed in the pe ...
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#1Anil K. Roy (Emory University)H-Index: 4
#2Nefize Turan (Emory University)H-Index: 6
Last. Gustavo Pradilla (Emory University)H-Index: 27
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Surgical treatment of deep subcortical lesions presents unique technical challenges related to atraumatic access with appropriate illumination and instrumentation in deep corridors. Advances in MRI technique with diffusion tensor imaging and whole brain tractography now allow for the development of minimally invasive parafascicular corridors to lesions. The combination of this technique with port-based approaches has significantly widened our surgical armamentarium. In this chapter, we discuss t...
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#1Audrey M Thiebaut (UNICAEN: University of Caen Lower Normandy)H-Index: 2
#2Maxime Gauberti (UNICAEN: University of Caen Lower Normandy)H-Index: 19
Last. Benoit D. Roussel (UNICAEN: University of Caen Lower Normandy)H-Index: 18
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Summary Although recent technical advances in thrombectomy have revolutionised acute stroke treatment, prevalence of disability and death related to stroke remain high. Therefore, plasminogen activators—eukaryotic, bacterial, or engineered forms that can promote fibrinolysis by converting plasminogen into active plasmin and facilitate clot breakdown—are still commonly used in the acute treatment of ischaemic stroke. Hence, plasminogen activators have become a crucial area for clinical investigat...
9 CitationsSource
#1Leonardo Lorente (Hospital Universitario de Canarias)H-Index: 33
#2María M. MartínH-Index: 16
Last. Victor García-Marín (Hospital Universitario de Canarias)H-Index: 6
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Objective Oxidative stress has been associated with secondary brain injury after spontaneous intracerebral hemorrhage (SIH). Malondialdehyde (MDA) appears in blood during lipid oxidation. Higher serum MDA levels have been found in patients with SIH than in healthy controls; however, we have not found data indicating an association between elevated serum MDA and early mortality in this population. This was the main objective of our study. Methods MDA levels were measured in serum samples obtained...
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