Age as a prognostic factor in relation to surgical evacuation of spontaneous supratentorial intracerebral haemorrhage.

AIM AND CLINICAL RATIONALE FOR THE STUDY: Spontaneous intracerebral haemorrhage (sICH) is an acute life-threatening injury and constitutes 10-15% of first-ever stroke cases. The Surgical Trials in Intracerebral Haematoma studies (STICH and STICH II) represent the two foremost studies in the field, however, with arguable shortcomings. To find more accurate criteria, we aimed to correlate the preoperative neurological and neuroimaging findings with the clinical outcome of operated patients. MATERIALS AND METHODS: In this retrospective study, sICH patients were recruited from the Central Denmark Region from 2010 to 2016. We evaluated the patients' medical records regarding preoperative Glasgow Coma Scale (GCS) 6 months and one year after surgery, focal neurological defects, thrombolytic treatment, pupil status, and haemorrhage localization visualized by neuroimaging. The patients' clinical outcome was assessed using the Glasgow Outcome Scale (GOS). RESULTS: Based on logistic multiple linear analysis, age, basal ganglia haemorrhage and mass effect had significant effect on the mortality rate. Besides, age, basal ganglia haemorrhage, intra ventricular haemorrhage and pupil difference had significant correlation with good outcome (GOS>3). CONCLUSIONS AND CLINICAL IMPLICATIONS: Neurosurgical treatment of the sICH patients is indicated only if age and potentially improved morbidity is carefully evaluated considering the STICH and this study; otherwise, we will just increase the health care burden with a number of extremely care-dependent patients.

Recurrence of chronic subdural haematomata with and without post-operative drainage.

Chronic subdural haematoma is a common disease causing morbidity and mortality. Recurrence after surgical treatment is common, varying from 5% to 30% of cases. Several methods for reducing recurrence have been advocated. The aim of this study was to investigate the effect of post-operative subdural drainage. Three hundred forty-four patients were included in a retrospective study. Treatment was performed by burr hole irrigation. Groups were separated into those with post-operative drainage compared to those without. Recurrence occurred in 14% in the drained group, significantly less than 26% in the undrained group (p=0.011). There were no differences in the complication rates. Post-operative drainage reduces recurrence of chronic subdural haematoma without increasing the complication rate. These results support those reported in several other studies. We recommend the use of post-operative subdural drainage.