gms | German Medical Science

Objective: The role of surgical therapy of supratentorial spontaneous intracerebral haemorrhage (SICH) is one of the most debated areas of neurosurgery. First publications have recently shown that perfusion parameters can provide additional information in patients with SICH. The aim of the present study was to analyze perfusion parameters in patients with SICH by PCT mapping in order to obtain additional hemodynamic information in the initial phase and the early postoperative course.

Methods: So far, 30 patients suffering from supratentorial SICH were included in this prospective study. Informed consent was obtained from the patient or a legal representative. At admission to our intensive care unit, patients received an initial PCT within 12 hours after symptom onset followed by a second PCT examination within 12 hours after surgery. The evaluators of PCT were blinded to the clinical course. For the PCT investigation, the equator of the hematoma was defined as the corresponding scanning level to calculate mean transit time (MTT), time to peak (TTP), cerebral blood flow (CBF) and cerebral blood volume (CBV) in a 360 degree cortical banding analysis.

Results: 30 patients with a mean age of 62.3±11.1 years and a mean hematoma volume of 61.5± 44.6 ml were included for PCT screening. On initial PCT MTT, TTP, CBF and CBV were significantly impaired (n=30, p<0.0001) in the lesioned hemisphere and perihemorrhagic zone compared to the contralateral hemisphere. Furthermore, all parameters were significantly impaired (p<0.005) in the hemorrhagic core in comparison to the mirrored area of the contralateral hemisphere. There was no correlation between any of the perfusion parameters and hematoma volume. The hemodynamic parameters improved significantly (p<0.005) after surgical therapy of SICH on the lesioned and even on the contralateral hemisphere. After surgical treatment the hemispheric and focal measurements did not differ significantly (p<0.9) between the ipsilateral and contralateral hemisphere.

Conclusions: The current study demonstrates that patients with supratentorial SICH suffer from hemispheric and focal perfusion deficits as measured by PCT. Furthermore the analysis revealed that early surgical hematoma removal leads to a significant improvement of the perfusion status. As a result an integration of perfusion measurement to widely used parameters such as age, neurological status and hematoma size in a clinical trial would be of strongest interest.