Surgical results for hypertensive intracerebral hemorrhagesdepending on intervention timing

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Abstract

Study aim. To analyse the surgical outcomes in patients with haemorrhagic stroke depending on the timing of surgery.

Materials and methods. We performed a retrospective analysis of 500 patients (335 (67%) men and 165 (33%) women), who underwent surgical treatment of hypertensive intracranial hemorrhages at the N.V. Sklifosovsky Research Institute for Emergency Medicine between 1997 and 2020. The mean patient age was 53.1 ± 12.2 years. The mean time until surgery was 3.3 ± 2.6 days. Outcomes were assessed on day 30 from disease onset using the modified Rankin Scale (mRS).

Results. In the total sample, outcomes as measured by the mRS were as follows: type 0 — 84 (16.8%) patients, type 1 — 37 (7.4%), type 2 — 46 (9.2%), type 3 — 38 (7.6%), type 4 — 43 (8.6%), type 5 — 142 (28.4%) and type 6 — 110 (22.0%). Treatment results were better when surgery was delayed (χ2 = 64.4; p < 0.00001). Mortality was 36.4% after surgery conducted in the first day after haemorrhage, while mRS scores of 0–2 made up 18.6%. Mortality was 20.4% after surgery conducted on the second or third day, and mRS scores of 0–2 made up 29.6%. Mortality was 17.4% after surgery conducted on day 4–7, and mRS scores of 0–2 outcomes were present in 49.0% of subjects. Mortality was 8.8% when surgery was performed on day 8 or later, and favourable outcomes were present in 48.5% of patients.

Conclusion. Intracerebral haematoma excision on day 2–3 leads to better outcomes in patients with reduced levels of alertness up to sopor, while surgery after day 3 leads to better results in alert patients and those with obtundation.

About the authors

Vladimir G. Dashyan

N.V. Sklifosovsky Research Institute for Emergency Care; A.I. Evdokimov Moscow State Medicine and Dentistry University

Email: i.godkov@yandex.ru
ORCID iD: 0000-0002-5847-9435

D. Sci. (Med.), Professor, Department of neurosurgery and neurocritical care, leading researcher, Neurosurgical department

Russian Federation, Moscow; Moscow

Ivan M. Godkov

N.V. Sklifosovsky Research Institute for Emergency Care

Author for correspondence.
Email: i.godkov@yandex.ru
ORCID iD: 0000-0001-8651-9986

Cand. Sci. (Med.), senior researcher, Neurosurgical department

Russian Federation, Moscow

Leonid V. Prokop’ev

A.I. Evdokimov Moscow State Medicine and Dentistry University; Irkutsk Regional Clinical Hospital

Email: i.godkov@yandex.ru
ORCID iD: 0000-0001-5356-2478

neurosurgeon

Russian Federation, Moscow; Irkutsk

Andrey A. Grin

N.V. Sklifosovsky Research Institute for Emergency Care; A.I. Evdokimov Moscow State Medicine and Dentistry University

Email: i.godkov@yandex.ru
ORCID iD: 0000-0003-3515-8329

D. Sci. (Med.), Professor, Chief neurosurgeon of the Moscow Healthcare Department, Department of neurosurgery and neurocritical care, Head, Science division, Neurosurgical department

Russian Federation, Moscow; Moscow

Vladimir V. Krylov

N.V. Sklifosovsky Research Institute for Emergency Care; A.I. Evdokimov Moscow State Medicine and Dentistry University

Email: i.godkov@yandex.ru
ORCID iD: 0000-0001-5256-0905

D. Sci. (Med.), Professor, Full member of RAS, Honored Scientist of the Russian Federation, Head, Department of neurosurgery and neurocritical care, chief researcher, Neurosurgical department

Russian Federation, Moscow; Moscow

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Copyright (c) 2021 Dashyan V.G., Godkov I.M., Prokop’ev L.V., Grin A.A., Krylov V.V.

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