gms | German Medical Science

70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

Mortality and functional outcome after surgical haematoma evacuation in cerebellar intracerebral haemorrhage – an international multicentre individual patient data meta-analysis

Mortalität und funktionelles Outcome nach Hämatomevakuation der zerebellären intrazerebralen Blutung – Ergebnisse einer internationalen, multizentrischen Metaanalyse

Meeting Abstract

Suche in Medline nach

  • presenting/speaker Hagen Huttner - Neurologische Univ.-Klinik Erlangen, Erlangen, Deutschland
  • RETRACE study group - Neurologische Univ.-Klinik Erlangen, Erlangen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV063

doi: 10.3205/19dgnc078, urn:nbn:de:0183-19dgnc0783

Veröffentlicht: 8. Mai 2019

© 2019 Huttner et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Objective: The influence of surgical haematoma evacuation (SHE) on outcome in patients with cerebellar intracerebral haemorrhage (cICH) is unestablished. We aimed to determine the influence of SHE on functional outcome and mortality in cICH.

Methods: This multicenter study pooled individual-level data contributed by 64 hospitals across the USA and Germany (2006–2015). We addressed compared SHE versus conservative treatment. The primary outcome was the dichotomised modified Rankin-scale (mRS) 0–3 at three months. Secondary outcomes included mortality at three months, 12 months, and mRS 0–3 at 12 months. We evaluated predicted probabilities to identify treatment related cut-off-values for ICH-volume and the Glasgow-Coma-Scale (GCS) with outcomes, which were further validated using patient-centered-outcome and observed data-estimates.

Results: We screened 6954 ICH-patients and identified 613 cICH. Patients treated with SHE (n=184) compared to conservative (n=429) showed lower GCS, larger ICH-volumes, and more frequent intraventricular haemorrhage (all p<0.001). After matching and adjustments, SHE was not significantly associated with the primary outcome (commonOR [cOR]: 0.767, 95% CI0.341-1.726; p=0.521). Patients treated with SHE showed reduced mortality rates at three (cOR: 0.330, 95% CI0.115-0.946; p=0.039) and 12 months (cOR: 0.301, 95% CI0.132-0.685; p=0.004), but functional outcome at 12 months was reduced (SHE: 47/162 (29.0%) versus 64/162 (39.5%); p=0.047). We identified significant cut-off-values for SHE with ICH-volumes below 12 ml being associated with a reduced primary outcome (cOR: 0.42, 95% CI0.19-0.93; p=0.03) and with ICH-volumes between 15-30ml (cOR: 0.23, 95% CI0.10-0.52; p<0.001) being associated with a reduced mortality.

Conclusion: SHE was not associated with improved functional outcome three months after cICH. Although mortality was reduced at three and 12 months, SHE was associated with larger proportions of patients being dependent at 12 months. It is unlikely, that randomized trials will be performed to address this question. Based on our data we conclude that SHE should be avoided in patients with ICH-volumes <12ml, and should be considered for mortality reduction in patients with ICH-volumes above 15ml.