Document Detail

Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage.
MedLine Citation:
PMID:  11376176     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: A modest benefit was previously demonstrated for hematoma evacuation within 12 hours of intracerebral hemorrhage onset. Perhaps surgery within 4 hours would further improve outcome. METHODS: Adult patients with spontaneous supratentorial intracerebral hemorrhage were prospectively enrolled. Craniotomy and clot evacuation were commenced within 4 hours of symptom onset in all cases. Mortality and functional outcome were assessed at 6 months. This group of patients was compared with patients treated within 12 hours of symptom onset using the same surgical and medical protocols. RESULTS: The study was stopped after a planned interim analysis of 11 patients in the 4-hour surgery arm. Median time to surgery was 180 minutes; median hematoma volume was 40 mL; median baseline NIH Stroke Scale score was 19 and Glasgow Coma Scale score was 12. Six-month mortality was 36% and median Barthel score was 75 in survivors. Postoperative rebleeding occurred in four patients, three of whom died. A relationship between postoperative rebleeding and mortality was apparent (p = 0.03). Rebleeding occurred in 40% of the patients treated within 4 hours, compared with 12% of the patients treated within 12 hours (p = 0.11). There was a clear correlation between improved outcome and smaller postsurgical hematoma volume (p = 0.04). CONCLUSIONS: Surgical hematoma evacuation within 4 hours of symptom onset is complicated by rebleeding, indicating difficulty with hemostasis. Maximum removal of blood remains a predictor of good outcome.
L B Morgenstern; A M Demchuk; D H Kim; R F Frankowski; J C Grotta
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurology     Volume:  56     ISSN:  0028-3878     ISO Abbreviation:  Neurology     Publication Date:  2001 May 
Date Detail:
Created Date:  2001-05-28     Completed Date:  2001-06-28     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1294-9     Citation Subset:  AIM; IM    
Stroke Program, Department of Neurology, University of Texas-Houston Medical School, 77030, USA.
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MeSH Terms
Aged, 80 and over
Brain / physiopathology,  radiography,  surgery
Cerebral Arteries / pathology,  physiopathology,  surgery
Cerebral Hemorrhage / physiopathology*,  radiography,  surgery*
Craniotomy / adverse effects*
Hematoma / physiopathology,  radiography,  surgery
Middle Aged
Pilot Projects
Postoperative Hemorrhage / prevention & control*,  radiography
Prospective Studies
Survival Rate
Tomography, X-Ray Computed
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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