Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 2020 , Vol 11, Issue 3
Surgical Treatment of Spontaneous Intracerebral Hematomas
Habibullah Dolgun1,Şahin Hanalioğlu1,Levent Gürses1,Gülce Gel1,İbrahim Başar2,Ahmet Günaydın1,Erhan Türkoğlu1
1Sağlık Bilimleri Üniversitesi Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi, Beyin ve Sinir Cerrahisi Kliniği, Ankara, Türkiye
2Sağlık Bakanlığı Siirt Devlet Hastanesi, Beyin ve Sinir Cerrahisi Kliniği, Siirt, Türkiye
DOI : 10.31067/0.2020.293 Objective: Intracerebral hematomas (ICH) comprise one-fifth of all strokes and is associated with high mortality and morbidity rates. We aimed to analyze the clinical-radiological features, surgical treatment indications and results of spontaneous ICH in a large clinical series from a single institution.

Materials and Methods: All patients who are older than 18 years of age and underwent surgery for spontaneous ICH between January 2006 and December 2017 were included. Patient charts, radiological images, operation notes and follow-up results were retrospectively evaluated. Data about age, sex, risk factors, neurological status at presentation, location and size of the hematoma, surgical technique, postoperative neurological outcomes, reoperation and follow-up results were collected.

Findings: A total of 88 patients ((30 female (34.1%), 58 male (65.9%)) were operated for spontaneous ICH. Mean age was 59.3±20.1 years (range: 18?89, median: 62). The main symptoms and signs were loss of consciousness, nausea-vomiting, severe headache, agitation, seizure and motor weakness (hemiplegia). Patients were admitted at varying times from 20 minutes to 5 hours following the symptom onset. Decompressive hemicraniectomy + hematoma aspiration was performed in 74 (84.1%) patients whereas 14 patients underwent craniotomy + hematoma aspiration. External ventricular drainage was required in 22 (25%) of 58 patients (65.9%) who had an intraventricular bleed. Recurrent bleeding or increased hematoma size was detected in 5 (5.7%) of 37 (42%) patients using antiaggregant/anticoagulant agents. Forty-seven (53.4%) patients died within the first 30 days after bleeding. The 30-day mortality rate was 88% in patients with GCS ?8 and blood volume >70 cm3.

Conclusion: ICH is more common in elderly, hypertensive patients with a history of antiaggregant/anticoagulant use. The older age, multiple comorbid diseases, large hematoma volume, low GCS at presentation are associated with poor prognosis. An early and effective surgical treatment can be life-saving especially in patients who are young, have no comorbid disease and a relatively good neurological state or with a sudden worsening. Keywords : intracerebral hematoma, hemorrhagic stroke, surgery, decompression, craniectomy