Determination of Factors affecting outcome of surgery in patients with spontaneous intracerebral hemorrhages

Spontaneous intracerebral hemorrhage (ICH) is a common disease. Among cerebrovascular accidents, ICH is the most fatal subtype and many of the survivors may be severely disabled. Comatose patients with these hemorrhages constitute a very special subgroup because of the high mortality rate and more uncertainty about the best surgical indications. Therefore, this study aimed to evaluate the factors affecting surgical results of ICH in these patients. In this cross-sectional retrospective study, 50 patients with spontaneous ICH participated who were treated by surgery at Urmia Imam Khomeini hospital between 2008-2013, and whose GCS(Glasgow Coma Scale) was ≤ 8. Outcome of patients was assessed by Glasgow outcome scale at the time of discharge from the hospital. Patients were evaluated in regard with such factors as level of consciousness before surgery, age, gender, hypertension, size and volume of hematoma and ventricular extension of hematoma. 50 patients with the mean age of 49±11.4 years were evaluated. Glasgow coma scale in 16 patients was less than 5 and in 34 patients was 5 to 8. Volume of hematoma was small in 4 patients, medium in 18 patients, and large in 28 patients. Hematoma did not extend to ventricular system in 28 cases, whereas in 22 cases hematoma was extended to ventricles. Furthermore, mortality rate was reported 52% in our series. The study results indicated level of consciousness before surgery, volume of hematoma and ventricular extension of hematoma meaningfully affected the outcome. No relationship was observed between such variables as age, gender, hypertension and outcome. The findings of the present study revealed that within comatose patients with spontaneous ICH, the better the level of consciousness before surgery, the smaller hematoma volume and no ventricular extension of hematoma, the better the outcome will be.