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

Journal article
Authors A. Fahlstrom
L. Tobieson
H. N. Redebrandt
H. Zeberg
J. Bartek
Andreas Bartley
M. Erkki
A. Hessington
E. Troberg
S. Mirza
P. P. Tsitsopoulos
N. Marklund
Published in Acta Neurochirurgica
Volume 161
Issue 5
Pages 955-965
ISSN 0001-6268
Publication year 2019
Published at Institute of Neuroscience and Physiology, Department of Clinical Neuroscience
Pages 955-965
Language en
Keywords Intracerebral haemorrhage, Surgery, Guidelines, Craniotomy, External ventricular drain, Intraventricular haemorrhage, initial conservative treatment, early surgical-treatment, intraventricular hemorrhage, international variations, putaminal, hemorrhage, early surgery, management, stich, hematomas, trial, Neurosciences & Neurology, Surgery
Subject categories Neurosciences


BackgroundSupratentorial 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.ObjectiveIn this nation-wide retrospective observational study, differences in treatment strategies among all neurosurgical departments in Sweden were evaluated.MethodsPatient 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.ResultsIn 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%.ConclusionsAlthough 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.

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