Shaaban Ahmed, Saqqur Maher, Saleh Ahmed, Ahmed Alaaeldin, Hussain Hussain, Babu R Arun, Alyafai Abdulnasser, Belkhair Sirajeddin, Ayyad Ali
Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar. E-mail:
Department of Medicine Division of Neurology, University of Alberta, Edmonton, Alberta, Canada.
Qatar Med J. 2021 Oct 18;2021(3):53. doi: 10.5339/qmj.2021.53. eCollection 2021.
Intracerebral hemorrhage (ICH) remains a devastating disease with high morbidity and mortality. The mortality rate ranges from 40% at 1 month to 54% at 1 year, and only 12%-39% achieve good outcomes and functional independence. The current management guidelines for spontaneous supratentorial ICH are still controversial.
Patients who presented with ICH and underwent craniotomy with hematoma evacuation or minimal procedures from January 2016 to May 2020 were included in the analysis. Several clinical, radiological, and surgical variables were collected to identify the variables most likely related to lower mortality and better functional outcomes.
A total of 87 patients presented with HMC with ICH from January 2016 to May 2020. The mean age was 44.7 (42.2-47.2) years. There were 76 male (87.4%)/11 female (12.6%) patients, which reflect the population distribution in Qatar, which is mainly male predominant. Although Qatar is mainly a Middle-Eastern country, the ethnic distribution of patients was mainly of South Asian and Indian (60.9%) and Far-Eastern (20.7%) ethnicities because of diversity. The mean baseline Glasgow coma scale (GCS) was 8.2+/ - 3.7. The mean baseline functional independence measure (FIM) score was 59.4+/ - 36.7. Most hematomas were located in the basal ganglia (79.3%%). Baseline characteristics based on long-term outcomes are summarized in Table 1. The following variables were correlated with poor outcome: low GCS on postoperative day 1 (P = 0.06), low FIM score (P = 0.006), ICH location (P = 0.04), distance of the closest point to the surface (P = 0.009), and presence of uncal herniation (P = 0.04). The baseline characteristics based on mortality are outlined in Table 2. The following variables were correlated with mortality: diabetes mellitus (P = 0.02), baseline GCS (P = 0.04), GCS on postoperative day 1 (P = 0.002), unequal pupils (P = 0.05), and postoperative midline shift (P = 0.001).
The preoperative clinical neurological status as well as mass effect (uncal herniation and midline shift) can be determinants of functional outcome and mortality. A deeper hematoma may result in poor functional outcome because of more surgical damage in functional brain tissues. Thus, the goal of surgery in spontaneous supratentorial ICH is to reduce mortality, but no evidence support that it can improve functional outcome. Although our findings are interesting, more prospective studies with a larger sample size are needed to confirm our results.
脑出血（ICH）仍然是一种具有高发病率和死亡率的毁灭性疾病。死亡率从1个月时的40%到1年时的54%不等，只有12%-39%的患者能获得良好结局和功能独立。目前自发性幕上脑出血的管理指南仍存在争议。
分析2016年1月至2020年5月期间出现脑出血并接受开颅血肿清除术或微创操作的患者。收集了多个临床、放射学和手术变量，以确定最有可能与较低死亡率和更好功能结局相关的变量。
2016年1月至2020年5月期间，共有87例因脑出血出现血肿扩大（HMC）的患者。平均年龄为44.7（42.2-47.2）岁。有76例男性（87.4%）/11例女性（12.6%）患者，这反映了卡塔尔以男性为主的人口分布情况。尽管卡塔尔主要是一个中东国家，但由于人口多样性，患者的种族分布主要是南亚和印度裔（60.9%）以及远东裔（20.7%）。平均基线格拉斯哥昏迷量表（GCS）为8.2±3.7。平均基线功能独立性测量（FIM）评分为59.4±36.7。大多数血肿位于基底节区（79.3%）。基于长期结局的基线特征总结于表1。以下变量与不良结局相关：术后第1天GCS低（P=0.06）、FIM评分低（P=0.006）、脑出血位置（P=0.04）、距表面最近点的距离（P=0.009）以及钩回疝的存在（P=0.04）。基于死亡率的基线特征概述于表2。以下变量与死亡率相关：糖尿病（P=0.02）、基线GCS（P=0.04）、术后第1天GCS（P=0.002）、瞳孔不等大（P=0.05）以及术后中线移位（P=0.001）。
术前临床神经学状态以及占位效应（钩回疝和中线移位）可能是功能结局和死亡率的决定因素。血肿较深可能由于对功能脑组织的手术损伤更大而导致功能结局不佳。因此，自发性幕上脑出血的手术目标是降低死亡率，但没有证据支持其能改善功能结局。尽管我们的发现很有趣，但需要更多样本量更大的前瞻性研究来证实我们的结果。
