gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

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Functional outcome one year after surgery for primary intracerebral hemorrhage

Funktionelles Ergebnis ein Jahr nach chirurgischer Therapie primärer intrazerebraler Blutungen

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  • corresponding author M. Ortler - Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Österreich
  • G. Gleissenthal - Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Österreich
  • P. Kavakebi - Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Österreich
  • C. Unterhofer - Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Österreich
  • E. Schmutzhard - Universitätsklinik für Neurologie, Medizinische Universität Innsbruck, Österreich
  • K. Twerdy - Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Österreich

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocP 066

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2007/07dgnc321.shtml

Published: April 11, 2007

© 2007 Ortler et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: To determine the functional outcome in patients who underwent microsurgery for primary intracerebral hemorrhage in a retrospective study.

Methods: Clinical and functional outcome one month and one year after surgical therapy for primary intracerebral hemorrhage were evaluated using the Glasgow Outcome Scale(GOS), the modified Rankin Scale (mRS) and the Barthel Score in a series of 110 patients. Demographic, clinical (including Glasgow Coma Score, GCS), imaging (including hematoma volume according to the formula a.b.c/2) and coagulation parameters were correlated with outcome parameters. The presence of seizures was noted.

Results: Median interval between bleeding and surgery was 0 days (range 0 - 19 days). Median GCS prior to surgery was 6. Mortality after one month and after one year was 26.4% and 54.2%, respectively. After one year a good clinical outcome (GOS 4 and 5, or mRS 0-2) was obtained in 33.3% (GOS) and 17.3% (mRS). Statistically significant predictors of good outcome after one year were younger age (p=0.04), higher initial GCS (p=0.0001) and lower postoperative PTT (p=0.023).Patients undergoing craniotomy for supratentorial hematoma evacuation suffered from chronic symptomatic epilepsy more often than patients treated by external ventricular drainage (43.6% vs 2.8% in patients with lobar hemorrrhage and 23.3 vs 0% with deep hemorrhage).

Conclusions: About 20% of patients undergoing surgery for primary intracerebral hemorrhage are able to live independently. Postoperative optimization of coagulation parameters may influence outcome. Microsurgical hematoma evacuation may increase the incidence of symptomatic epilepsy. Functional outcome categorization with GOS is inadequate.