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Journal of Neurosurgical Sciences 2020 Sep 24

DOI: 10.23736/S0390-5616.20.04940-1


lingua: Inglese

Natural history and surgical management of spontaneous intracerebral hemorrhage: a systematic review

Jonathan RYCHEN 1, Anthea O\\\'NEILL 2, Leon T. LAI 2, David BERVINI 3

1 Department of Neurosurgery, Basel University Hospital, Basel, Switzerland; 2 Department of Neurosurgery, Monash Health, Melbourne, Australia; 3 Department of Neurosurgery, Inselspital, Bern University Hospital, Bern, Switzerland


INTRODUCTION: Management of spontaneous intracerebral hemorrhage (ICH) remains controversial despite efforts to produce high level evidence in the years past. We systematically examined the pooled literature data on the natural history and surgical management of ICH.
EVIDENCE ACQUISITION: A systematic review was performed using the PubMed and Embase databases, encompassing English, full-text articles, reporting treatment outcomes for the conservative and surgical management of ICH.
EVIDENCE SYNTHESIS: A total of 91 studies met the eligibility criteria (total of 16,411 ICH cases). The most common locations for an ICH were the basal ganglia for both the conservative (68.7%) and surgical cohorts (58.4%). Patients in the non-operative group (40.5%) were older (mean age 62.9 years; range 12.0-94.0), had a higher Glasgow Coma Scale (GCS) score at presentation (mean GCS 10.2; range 3-15) and lower ICH volume (mean 36.9 mL). When managed non-operatively, a favorable functional outcome was encountered in 25.7% (95% CI 16.9-34.5) of patients, with a 22.2% (95% CI 16.6-27.8) mortality rate. Patients who underwent surgery (59.5%) were younger (mean age 58.8 years; range 12.0-94.0), had a lower GCS at presentation (mean GCS 8.2; range 3-15) and larger ICH volume (mean 58.3 mL; range 8.2-140.0). Craniotomy with hematoma evacuation was the preferred surgical technique (38.6%). A favorable functional outcome was encountered in 29.8% (95% CI 23.8-35.8) of operated patients, with a 21.3% (95% CI 16.3-26.3) mortality rate.
CONCLUSIONS: For many ICH cases, the reviewed literature allows to define surgical and conservative candidates. However, there are still some ICH-cases where management remains controversial.

KEY WORDS: Spontaneous intracerebral hemorrhage; Natural history; Conservative therapy; Surgical therapy; Neurosurgical procedures; Neurosurgery; Surgical decompression; Craniotomy; Treatment outcome

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