Prognosis of Surgical Management for Intracerebral Hemorrhage: Insights from Indonesia's National Brain Center Hospital

Dimas Rahmatisa, Joshua Eldad Frederich Lasanudin

Abstract


Background and Objective: Intracerebral hemorrhage (ICH), a stroke subtype that can be managed surgically, exhibits varying prognoses amongst countries. However, data for the Indonesian population are currently lacking.
Subject and Methods: In a retrospective cohort study, medical records of post-surgical ICH cases in Rumah Sakit Pusat Otak Nasional from January 2021 to April 2023 were obtained. Prognostic data includes hospitalization duration, in-hospital mortality, and dependency upon discharge. Multivariate analysis was performed on sociodemographic and medical data to determine prognostic factors.
Results: A total of 157 cases were obtained. Procedures performed include hemorrhage evacuation craniotomies (58.6%), burr holes (29.9%), ventriculoperitoneal shunts (24.2%), and decompressive craniectomies (5,1%), with 15.9% patients undergoing multiple surgical sessions. In-hospital mortality and total dependency occurred in 31.2% and 54.6% of patients, respectively. Average hospitalization is 16.32 days. Predictors for in-hospital mortality are age ≥ 50 years (p=0.002), male (p=0.014), hematoma volume > 40mL (p=0.012), multiple surgical sessions (p=0.034), and presenting Glasgow Coma Scale (GCS) < 9 (p=0.015). Predictors for total dependency are supratentorial lesions (p=0.025) and presenting GCS 9-12 (p=0.008) and < 9 (p=0.002). Predictors for hospitalization > 2 weeks are stroke onset > 3.5 hours (p=0.008) and multiple surgical sessions (p=0.001).
Conclusion: Surgical management of ICH in Indonesia reveals similar outcomes to other countries. However, differences in prognostic factors indicate potential variations between countries.


Keywords


Indonesia, intracerebral hemorrhage, prognosis

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References


An SJ, Kim TJ, Yoon BW. Epidemiology, Risk Factors, and Clinical Features of Intracerebral Hemorrhage: An Update. J Stroke. 2017 Jan;19(1):3–10. Doi: https://doi.org/10.5853/jos.2016.00864

Van Asch CJ, Luitse MJ, Rinkel GJ, Van Der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 2010;9(2):167–76. Doi: https://doi.org/10.1016/S1474-4422(09)70340-0

Thomas SM, Reindorp Y, Christophe BR, Connolly ES. Systematic Review of Resource Use and Costs in the Hospital Management of Intracerebral Hemorrhage. World Neurosurg. 2022;164:41–63. Doi: https://doi.org/10.1016/j.wneu.2022.04.055

Kuramatsu JB, Biffi A, Gerner ST, Sembill JA, Sprügel MI, Leasure A, et al. Association of surgical hematoma evacuation vs conservative treatment with functional outcome in patients with cerebellar intracerebral hemorrhage. JAMA. 2019;322(14):1392. Doi: https://doi.org/10.1001/jama.2019.13014

Yao Z, Ma L, You C, He M. Decompressive craniectomy for spontaneous intracerebral hemorrhage: A systematic review and meta-analysis. World Neurosurg. 2018 ;110:121–8. Doi: https://doi.org/10.1016/j.wneu.2017.10.167

Rodríguez-Fernández S, Castillo-Lorente E, Guerrero-Lopez F, RodríguezRubio D, Aguilar-Alonso E, Lafuente-Baraza J, et al. Validation of the ICH score in patients with spontaneous intracerebral haemorrhage admitted to the intensive care unit in Southern Spain. BMJ Open. 2018;8(8):e021719. Doi: https://doi.org/10.1136/bmjopen-2018-021719

Svensson EH, Abul-Kasim K, Engström G, Söderholm M. Risk factors for intracerebral haemorrhage - Results from a prospective population-based study. Eur Stroke J. 2020;5(3):278–85. Doi: https://doi.org/10.1177/2396987320932069

Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet. 2013 ;382(9890):397–408. Doi: https://doi.org/10.1016/S0140-6736(13)60986-1

Morioka J, Fujii M, Kato S, Fujisawa H, Akimura T, Suzuki M, et al. Surgery for spontaneous intracerebral hemorrhage has greater remedial value than conservative therapy. Surg Neurolog. 2006;65(1):67–72. Doi: https://doi.org/10.1016/j.surneu.2005.03.023

Luzzi S, Elia A, Del Maestro M, Morotti A, Elbabaa SK, Cavallini A, et al. Indication, timing, and surgical treatment of spontaneous intracerebral hemorrhage: Systematic review and proposal of a management algorithm. World Neurosurg. 2019;124:e769–78. Doi: https://doi.org/10.1016/j.wneu.2019.01.016

Zhou H, Zhang Y, Liu L, Han X, Tao Y, Tang Y, et al. A prospective controlled study: minimally invasive stereotactic puncture therapy versus conventional craniotomy in the treatment of acute intracerebral hemorrhage. BMC Neurol. 2011;11(1):76. Doi: https://doi.org/10.1186/1471-2377-11-76

Chen CC, Liu CL, Tung YN, Lee HC, Chuang HC, Lin SZ, et al. Endoscopic Surgery for Intraventricular Hemorrhage (IVH) Caused by Thalamic Hemorrhage: Comparisons of Endoscopic Surgery and External Ventricular Drainage (EVD) Surgery. World Neurosurgy. 2011;75(2):264–8. Doi: https://doi.org/10.1016/j.wneu.2010.07.041

Cai Q, Zhang H, Zhao D, Yang Z, Hu K, Wang L, et al. Analysis of three surgical treatments for spontaneous supratentorial intracerebral hemorrhage. Medicine (Baltimore). 2017 ;96(43):e8435. Doi: https://doi.org/10.1097/MD.0000000000008435

Gregório T, Pipa S, Cavaleiro P, Atanásio G, Albuquerque I, Chaves PC, et al. Prognostic models for intracerebral hemorrhage: systematic review and metaanalysis. BMC Med Res Methodol. 2018;18(1):145.

Salvadori E, Papi G, Insalata G, Rinnoci V, Donnini I, Martini M, et al. Comparison between ischemic and hemorrhagic strokes in functional outcome at discharge from an intensive rehabilitation hospital. Diagnostics (Basel). 2020;11(1):38. Doi: https://doi.org/10.3390/diagnostics11010038

Kim SM, Hwang SW, Oh EH, Kang JK. Determinants of the length of stay in stroke patients. Osong Public Health Res Perspect. 2013;4(6):329–41. Doi: https://doi.org/10.1016/j.phrp.2013.10.008

Luo L, Xu X, Jiang Y, Zhu W. Predicting intracerebral hemorrhage patients’ length-of-stay probability distribution based on demographic, clinical, admission diagnosis, and surgery information. J Healthcare Engineering. 2019;2019:1–12. Doi: ://doi.org/10.1155/2019/4571636




DOI: https://doi.org/10.24244/jni.v13i1.588

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