Comparison of Long-Term Outcomes in Patients with Supratentorial Spontaneous Intracerebral Hemorrhage Treated with and without Surgical Intervention.

Abstract

Background and objectives: Intracerebral hemorrhage (ICH) is associated with high mortality and morbidity. Uncertainty still exists regarding the benefit of surgery in the management of supratentorial spontaneous ICH (sICH), especially of the basal ganglia and thalamus. Studies have not shown the clinical benefit of early surgical management compared to best medical management plus delayed surgery, when necessary. Our aim was to compare the efficacy of different neurosurgical interventions with best medical management and best medical management alone.

Methods: We conducted a single-center, retrospective study at a tertiary care center in India in sICH patients between January 2015 and December 2022. The primary outcome was functional disability evaluated by the modified Rankin Scale (mRS) at 3, 6, and 12 months. Time-to-event outcomes were compared using the Kaplan-Meier curve.

Results: Among 2600 stroke patients screened, 661 had sICH. Median age was 55 years, and 250 patients (37.8%) underwent neurosurgical intervention. The most common intervention was craniotomy and hematoma evacuation. The median mRS at discharge and follow-up at 3, 6, and 12 months was lower in the conservatively managed group (4, 3, 3, and 3, respectively) compared to the surgical intervention group (5, 5, 5, 4, respectively). However, the ICH score at admission was lower in the conservatively managed group and after adjustment for ICH score, there was no statistically significant difference between the two. Among the interventions, patients undergoing decompression craniectomy had the best functional outcome.

Conclusions: Neurosurgical intervention was not associated with better functional outcome when compared to conservative management.