head JofIMAB
Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2019, vol. 25, issue2
Subject Area: Medicine
DOI: 10.5272/jimab.2019252.2471
Published online: 10 April 2019

Original article

J of IMAB. 2019 Apr-Jun;25(2):2471-2475
Maya P. Danovska1ORCID logo, Mladen E. Ovcharov2, Emilia M. Ovcharova1ORCID logo Corresponding Autoremail, Igor Mladenovski1ORCID logo, Nicholas Shepherd3,
1) Department of Neurology, University Hospital, Medical University, Pleven, Bulgaria.
2) Department of Neurosurgery, University Hospital, Medical University, Pleven, Bulgaria.
3) Student 5th year, Medical University, Pleven, Bulgaria.

Background: Spontaneous intracerebral hemorrhage (sICH) causes severe disability and high mortality. Today it is still an unresolved medical problem. The choice of optimal management - surgical or conservative, remains a difficult and controversial one. Early evacuation may restrict hematoma expansion and limit the secondary brain damage, improving the outcome for the patient.
Objective: To compare the effectiveness of surgical to conservative treatment of sICH.
Material and Methods: We examined 94 patients with sICH admitted to the Neurology Clinic within 24 hours ofonset. Forty seven patients underwent surgical evacuation and the remaining 47 received conservative medical therapy. Neurological deficit and clinical outcome were assessed by Glasgow Coma Scale (GCS), National Institutes of Health Stroke Scale (NIHSS) and Glasgow Outcome Scale (GOS). Each patient was assessed on two occasions, the first on admission and the second after one month. The statistical analysis was performed with the Statistical Package for Social Sciences, version 13.0 (SPSS).
Results: Neurological deficit, hematoma volume and location displayed correlation with GOS in the conservative group (p>0.05), while no statistical significance between GOS and hematoma volume in the surgical group (p<0.05) was observed. Surgically treated patients with a baseline GCS>12 had a better final GOS relative to conservatively treated ones. There was no statistically significant difference in GOS on the 30thday of treatment for both groups. The mortality of 4.3% was significantly lower in the surgical group (p<0.05).
Conclusion: Early surgery for sICH might be a safe and effective treatment, especially for large hematomas (>60cc) in male patients with progressive impairment of consciousness.

Keywords: Spontaneous intracerebral hemorrhage, surgical treatment, conservative management,

pdf - Download FULL TEXT /PDF 1979 KB/
Please cite this article as: Danovska MP, Ovcharov ME, Ovcharova EM, Mladenovski I, Shepherd N. Surgical Versus Conservative Treatment of Spontaneous Intracerebral Hemorrhage. J of IMAB. 2019 Apr-Jun;25(2):2471-2475. DOI: 10.5272/jimab.2019252.2471

Corresponding AutorCorrespondence to: Emilia Ovcharova, Department of Neurology and Neurosurgery, Medical University – Pleven; 1, St. Kliment Ochridski Str., Pleven, 5800, Bulgaria; E-mail: emilia_ovcharova@abv.bg

1.  Stamenov E, Stamenova P. Hemorrhagic stroke. Medicina i Fizkultura. 1988. [in Bulgarian]
2. Ribo M, Grotta JC. Latest advances in intracerebral hemorrhage. Curr Neurol Neurosci Rep. 2006 Jan;6(1):17-22. [PubMed]
3. Carandag R, Sudha S, Beiser A, Kelly-Hayes M, Kase CS, Kannel WB, et al. Trends in incidence, lifetime, risk, severity and 30-day mortality of stroke over the past 50 years. JAMA. 2006 Dec 27;296(24):2939-46. [PubMed] [CrossRef]
4. Morgenstern LB, Hemphill JC 3rd, Anderson C, Becker K, Broderick JP, Connolly ES Jr, et al. Guidelines for the management of spontaneous intracerebral hemorrhage. A Guideline for healthcare professionals from the American Heart Association. Stroke. 2010 Sep; 41(9):2108-29. [PubMed] [CrossRef]
5. Umebayashi D, Mandai A, Osaka Y, Nakahara Y, Tenjin H. Effects and complications of stereotacticaspiration for spontaneous intracerebral hemorrhage. Neurol Med Chir (Tokyo). 2010; 50(7):538-44 [PubMed] [Crossref]
6. Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomasin the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet. 2005 Jan 29-Feb 4;365(9457):387-97. [PubMed] [Crossref]
7. Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet. 2013 Aug 3;382(9890):397-408. [PubMed] [Crossref]
8. Teasdale G, Jennet B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul 13;304 (7872):81-4. [PubMed] [Crossref]
9. Bessenyei M, Fekete I, Csiba L, Bereczki D. Characteristics of 4 stroke scales for the detection of changes in clinical signs in the acute phase of stroke. J Stroke Cerebrovasc Dis. 2001 Mar-Apr;10(2):70-8. [PubMed] [Crossref]
10. Van Swieten JC, Koudstaal PJ, Visser MC, Schoutten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988 May;19(5):604-7. [PubMed] [Crossref]
11. Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G. Volume of intracerebral hemorrhage.A powerful and easy to use predictor of 30-day mortality. Stroke. 1993 Jul;24(7):987-93. [PubMed] [Crossref]
12. Schwarz S, Jauss M, Krieger D, Dörfler A, Albert F, Hacke W. Hematoma evacuation does not improve outcome in spontaneous supratentorial intracerebral hemorrhage:a case-control study. Acta Neurochir (Wien). 1997;139(10):897-903. [PubMed]
13. Danovska M, Alexandrova M, Totsev N, Gencheva I, Stoev P. Clinical and Neuroimaging Studies in Patients with Acute Spontaneous Intracerebral Hemorrhage. J of IMAB. 2014 Jan-Jun;20(2):489-494. [Crossref]
14. Bhaskar MK, Kumar R, Ojha B, Singh SK, Verma N, Verma R, et al. A randomized controlled study of operative versus nonoperative treatment for large spontaneous supratentorial intracerebral hemorrhage. Neurol India. 2017 Jul-Aug;65(4):752-758. [PubMed] [Crossref]
15. Mourad HS, Enab AA, Abdelalim AM. Early outcome of Conservative versus Surgical Treatment of Spontaneous Supratentorial Intracerebral Hemorrhage. Egypt J Neurol Psychiat Neurosurg. 2011; 48(1):85-92.
16. Kim HT, Lee JM, Koh EJ, Choi HY. Surgery versus Conservative Treatment for Spontaneous Supratentorial Intracerebral Hemorrhage in Spot Sign Positive Patients. J Korean Neurosurg Soc. 2015; 58(4):309–315. [PMC] [Crossref]
17. Zheng J, Li H, Guo R, Lin S, Hu X, Dong W, et al. Minimally invasive surgery treatment for the patients with spontaneous supratentorial intracerebral hemorrhage (MISTICH): protocol of a multi-center randomized controlled trial. BMC Neurol. 2014 Oct 10;14:206.  [PMC] [Crossref]
18. Mendelow AD. Operationversus non-operative treatment for spontaneoussupratentorial intracerebral haemorrhage: Is a changein current clinical practice required? Neurol India. 2017 Apr;65(4):759-60. [Crossref]
19. Luzzi S, Elia A, Del Maestro M, Morotti A, Elbabaa SK, Cavallini A, et al. Indication, Timing, and Surgical Treatment of Spontaneous Intracerebral Hemorrhage: Systematic Review and Proposal of a Management Algorithm. World Neurosurg. 2019 Jan 22. pii:S1878-8750(19)30105-6. [PubMed] [Crossref]
20. Hemphill JC, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, et  al. Guidelines for the management of spotnaneous intracerebral hemorrhage. A guideline for healthcare professionals from the American heart Association/American Stroke Association. Stroke. 2015; 46:2032-2060. [Crossref]
21. Islam MR, Haque MA, Khan AM, Rahman M, Asfia KN, Talukder MH, Salam A. Outcome of Surgical Management in Spontaneous Supratentorial Intracerebral Hemorrhage Patients: A Randomized Control Trial. J Natl Inst Neurosci Bangladesh. 2017; 3(1):37-41. [Crossref]

Received: 03 September 2018
Published online: 10 April 2019

back to Online Journal