Functional outcome at 6 months in surgical treatment of spontaneous supratentorial intracerebral haemorrhage
- Author:
Abdul Rahman Izaini Ghani
;
John Tharakan Kalappurakkal John
;
Zamzuri Idris
;
Mazira Mohamad Ghazali
;
Nur-Leem Murshid
;
Kamarul Imran Musa
- Publication Type:Journal Article
- Keywords:
intracerebral haemorrhage, regional cortical cerebral blood flow (rCoBF), surgery, Glasgow Outcome Scale
- From:Malaysian Journal of Medical Sciences
2008;15(4):48-55
- CountryMalaysia
- Language:English
-
Abstract:
A prospective cohort study was done to evaluate the role of surgery in patients with spontaneous supratentorial intracerebral haemorrhage (SICH) and to identify
predictors of outcome including the use of invasive regional cortical cerebral blood flow (rCoBF) and microdialysis. Surgery consisted of craniotomy or decompressive craniectomy. The ventriculostomy for intracranial pressure (ICP) monitoring and
drainage and regional cortical cerebral blood flow (rCoBF) and microdialysis were performed in all subjects. Pre and post operative information on subjects were
collected. The study end points was functional outcome at 6 months based on a dichotomised Glasgow Outcome Scale (GOS).The selected clinical, radiological,
biochemical and treatment factors that may influence the functional outcome were analysed for their significance. A total of 36 patients were recruited with 27(75%)
patients had Glasgow Coma Score (GCS) between 5 to 8 on admission and 9(25%) were admitted with GCS of 9. At 6 months, 86 % had a poor or unfavourable
outcome (GOS I-III) and 14% had good or favourable outcome (GOS IV-V). The mortality rate at 6 months was 55%. Univariate analysis for the functional outcome
identified 2 significant variables, the midline shift (p=0.013) and mean lactate:pyruvate ratio (p=0.038). Multivariate analysis identified midline shift as
the single significant independent predictor of functional outcome (p=0.013).Despite aggressive regional cortical cerebral blood flow (rCoBF) and microdialysis study
for detection of early ischemia, surgical treatment for spontaneous intracerebral haemorrhage only benefited a small number of patients in terms of favourable
outcome (14%) and in the majority of patients (86%), the outcome was unfavourable. Patients with midline shift > 5mm has almost 21 times higher chances
(adj) OR 20.8 of being associated with poor outcome (GOS I-III).
- Full text:W020151019539498259999.pdf
