Differences in neurosurgical treatment of intracerebral haemorrhage: a nation-wide observational study of 578 consecutive patients

Research output: Contribution to journalArticle

Abstract

Background: Supratentorial intracerebral haemorrhage (ICH) carries an excessive mortality and morbidity. Although surgical ICH treatment can be life-saving, the indications for surgery in larger cohorts of ICH patients are controversial and not well defined. We hypothesised that surgical indications vary substantially among neurosurgical centres in Sweden. Objective: In this nation-wide retrospective observational study, differences in treatment strategies among all neurosurgical departments in Sweden were evaluated. Methods: Patient records, neuroimaging and clinical outcome focused on 30-day mortality were collected on each operated ICH patient treated at any of the six neurosurgical centres in Sweden from 1 January 2011 to 31 December 2015. Results: In total, 578 consecutive surgically treated ICH patients were evaluated. There was a similar incidence of surgical treatment among different neurosurgical catchment areas. Patient selection for surgery was similar among the centres in terms of patient age, pre-operative level of consciousness and co-morbidities, but differed in ICH volume, proportion of deep-seated vs. lobar ICH and pre-operative signs of herniation (p <.05). Post-operative patient management strategies, including the use of ICP-monitoring, CSF-drainage and mechanical ventilation, varied among centres (p <.05). The 30-day mortality ranged between 10 and 28%. Conclusions: Although indications for surgical treatment of ICH in the six Swedish neurosurgical centres were homogenous with regard to age and pre-operative level of consciousness, important differences in ICH volume, proportion of deep-seated haemorrhages and pre-operative signs of herniation were observed, and there was a substantial variability in post-operative management. The present results reflect the need for refined evidence-based guidelines for surgical management of ICH.

Details

Authors
Organisations
External organisations
  • Uppsala University Hospital
  • Linköping University
  • Karolinska Institutet
  • Karolinska University Hospital
  • Copenhagen University Hospital
  • Sahlgrenska University Hospital
  • Norrland University Hospital
  • Skåne University Hospital
  • Uppsala University
  • University of Gothenburg
  • Umeå University
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Neurology
  • Surgery

Keywords

  • Craniotomy, External ventricular drain, Guidelines, Intracerebral haemorrhage, Intraventricular haemorrhage, Surgery
Original languageEnglish
Pages (from-to)955-965
JournalActa Neurochirurgica
Volume161
Issue number5
Early online date2019 Mar 15
Publication statusPublished - 2019
Publication categoryResearch
Peer-reviewedYes