Management of Spontaneous Superficial Intracerebral Hematomas

Abstract

Background: Treatment of primary spontaneous superficial intracerebral hemorrhage (SSICH) is still controversial. The aim of this study is to investigate the effectiveness of craniotomy and early hematoma evacuation vs conservative (non operative) management in patients with SSICH. Methods: A prospective study of craniotomy and early hematoma removal vs. medical management was performed in 20 patients with cortical and subcortical (superficial) primary SSICH admitted to Assiut university hospital in one year period (March 2016-March 2017). Surgical or medical treatment was initiated immediately when patients admitted to hospital. We divided the patients into two groups according to type of treatment. Results: Age of the patients ranged from 2 months to 73 years (mean: 45.84 ± 23.28 years) among the 20 patients studied; 13 (65%) were males and 7 (35%) were females. Glasgow coma scale (GCS) at admission was less than 8 in 25%, between 8 - 12 in 45% and 15 in 30% of the patients. Arterial hypertension was the most common associated medical disease (65%). Eleven of patients (55%) had ventricular extension. GCS at admission was the strongest factor affecting outcomes and determined the type of treatment. All patients with a GCS ≤ 8 (5 cases (25%) were died regardless the type of treatment and there was no significant statistical difference in this group in relation to type of treatment p-value (0.606). We had 6 cases (30%) with a GCS 15; all of them were treated conservatively and all of them survived with significant p-value (0.003). Nine patients (45%) had GCS 8 - 12; two of them were treated conservatively and died while the remaining seven patients were treated surgically; five of them survived with significant p-value (0.025). No significant statistical difference was found in the outcome between the surgical and the conservative group regarding having associated intracranial hemorrhage. Conclusions: After analyzing the results, we found that when the GCS is “8 - 12”, surgical intervention is recommended and carried a better prognosis than waiting for the conservative treatment. When GCS is higher “>12”, conservative treatment can be the favorable option. Otherwise, we found no statistical difference between surgical and conservative treatment in the treatment of ICH.