Surgical Treatment Could Improve Long-Term Functional Outcomes in Intracerebral Hemorrhage Patients With NIHSS ≥ 10.

BACKGROUND AND PURPOSE

Surgical treatment has been shown to decrease mortality in patients with intracerebral hemorrhage (ICH) but has not consistently improved functional outcomes. This study aimed to investigate whether surgical treatment could enhance functional outcomes in ICH patients with a National Institutes of Health Stroke Scale (NIHSS) score of 10 or higher.

METHODS

This multicenter study included patients from a registry cohort in China with supratentorial ICH, NIHSS scores of 10 or higher, and hematoma sizes of 25 mL or more. Patients were divided into surgical and medical treatment groups. The primary outcome was a modified Rankin Scale (mRS) score of 0-3 at 1 year.

RESULTS

A total of 429 patients were analyzed. The median NIHSS score at admission was 22 [15-29], and the ICH volume was 50 [35.28-72.9] ml. The surgical group had a higher proportion of mRS scores of 0-3 at 1 year compared to the medical group (49.68% vs. 38.32%, p = 0.022). Both craniotomy and minimally invasive surgery improved functional outcomes at 1 year (mRS 0-3, craniotomy: OR 2.324, 95% CI 1.266-4.267, p = 0.007; minimally invasive surgery: OR 4.884, 95% CI 1.914-12.445, p = 0.001).

CONCLUSION

For patients with supratentorial ICH, NIHSS scores of 10 or higher, and hematoma sizes of 25 mL or more, surgical treatment improved functional outcomes at 1 year compared to medical treatment. The specific subgroup of ICH patients that could benefit from surgical intervention remains controversial.