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Comparison of surgical and medical treatment in patients with spontaneous intracerebral hemorrhage

Yıl 2022, , 290 - 295, 27.09.2022
https://doi.org/10.18663/tjcl.1106642

Öz

Aim: Intracerebral hemorrhage (ICH) is a subtype of stroke whose risk factors are chronic hypertension, amyloid angiopathy, anticoagulants, and malformations. Primary or spontaneous ICH constitutes a significant portion of hemorrhagic strokes. Management of ICH ranges from medical management to open surgery. In this study, surgical and medical treatments applied to the patients were compared with the Glasgow Coma Scale (GCS).
Patients and Methods: A total of 32 patients with ICH were included in the study. Diagnosis was made by cranial computed tomography (CT) and magnetic resonance imaging (MRI) in all patients. Medical treatment was applied to 19 patients among the participants. Surgical treatment was applied to 13 patients. GCS points of patients presenting with intracerebral hematoma were recorded and compared at their first admission and after treatment.
Results: In this study, a total of eight patients died, four of whom were followed up with medical treatment and four of those who underwent surgical treatment. Participants were examined in terms of pre- and post-treatment GCS scores according to the location of the lesion. As a result of the analysis of the data obtained, it was determined that there was a significant difference between the GCS values of the participants before and after the surgical and medical treatment. The mean GCS values of those who were treated medically were higher than those who were treated surgically. GCS values were very close to each other after treatment and no statistically significant difference was found between the groups.
Conclusion: In the light of the findings obtained in the study, it was concluded that surgical treatment was not superior to medical treatment.

Kaynakça

  • 1. Ziai WC, Carhuapoma JR. Intracerebral Hemorrhage. Continuum (Minneap Minn). 2018 Dec;24(6):1603–22.
  • 2. Elliott J, Smith M. The acute management of intracerebral hemorrhage: a clinical review. Anesth Analg. 2010 May;110(5):1419–27.
  • 3. Flower O, Smith M. The acute management of intracerebral hemorrhage. Curr Opin Crit Care. 2011 Apr;17(2):106–14.
  • 4. Poon MTC, Bell SM, Al-Shahi Salman R. Epidemiology of Intracerebral Haemorrhage. Front Neurol Neurosci. 2015;37:1–12.
  • 5. Rymer MM. Hemorrhagic stroke: intracerebral hemorrhage. Mo Med. 2011;108(1):50–4.
  • 6. Balami JS, Buchan AM. Complications of intracerebral haemorrhage. Lancet Neurol. 2012 Jan;11(1):101–18.
  • 7. Siddique MS, Mendelow AD. Surgical treatment of intracerebral haemorrhage. Br Med Bull. 2000;56(2):444–56.
  • 8. Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke. 1996 Aug;27(8):1304–5.
  • 9. Xi G, Keep RF, Hoff JT. Mechanisms of brain injury after intracerebral haemorrhage. Lancet Neurol. 2006 Jan;5(1):53–63. 10. Morgenstern LB, Demchuk AM, Kim DH, Frankowski RF, Grotta JC. Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage. Neurology [Internet]. 2001 May 22;56(10):1294 LP – 1299. Available from: http://n.neurology.org/content/56/10/1294.abstract
  • 11. Zuccarello M, Brott T, Derex L, Kothari R, Sauerbeck L, Tew J, et al. Early surgical treatment for supratentorial intracerebral hemorrhage: a randomized feasibility study. Stroke. 1999 Sep;30(9):1833–9.
  • 12. Morgenstern LB, Frankowski RF, Shedden P, Pasteur W, Grotta JC. Surgical treatment for intracerebral hemorrhage (STICH): a single-center, randomized clinical trial. Neurology. 1998 Nov;51(5):1359–63.
  • 13. Gregson BA, Rowan EN, Francis R, McNamee P, Boyers D, Mitchell P, et al. Surgical Trial In Traumatic intraCerebral Haemorrhage (STITCH): a randomised controlled trial of Early Surgery compared with Initial Conservative Treatment. Health Technol Assess. 2015 Sep;19(70):1–138.
  • 14. Mendelow AD, Unterberg A. Surgical treatment of intracerebral haemorrhage. Curr Opin Crit Care. 2007 Apr;13(2):169–74.
  • 15. Gurol ME, St Louis EK. Treatment of cerebellar masses. Curr Treat Options Neurol. 2008 Mar;10(2):138–50.
  • 16. Miller CM, Vespa PM, McArthur DL, Hirt D, Etchepare M. Frameless stereotactic aspiration and thrombolysis of deep intracerebral hemorrhage is associated with reduced levels of extracellular cerebral glutamate and unchanged lactate pyruvate ratios. Neurocrit Care. 2007;6(1):22–9.
  • 17. Vespa P, McArthur D, Miller C, O’Phelan K, Frazee J, Kidwell C, et al. Frameless stereotactic aspiration and thrombolysis of deep intracerebral hemorrhage is associated with reduction of hemorrhage volume and neurological improvement. Neurocrit Care. 2005;2(3):274–81.
  • 18. Morgan T, Zuccarello M, Narayan R, Keyl P, Lane K, Hanley D. Preliminary findings of the minimally-invasive surgery plus rtPA for intracerebral hemorrhage evacuation (MISTIE) clinical trial. Acta Neurochir Suppl. 2008;105:147–51.
  • 19. Murthy JMK, Chowdary GVS, Murthy TVRK, Bhasha PSA, Naryanan TJ. Decompressive craniectomy with clot evacuation in large hemispheric hypertensive intracerebral hemorrhage. Neurocrit Care. 2005;2(3):258–62.
  • 20. Mitchell P, Gregson BA, Vindlacheruvu RR, Mendelow AD. Surgical options in ICH including decompressive craniectomy. J Neurol Sci. 2007 Oct;261(1–2):89–98.

Spontan intraserebral hemorajili hastalarda cerrahi ve medikal tedavilerin kıyaslanması

Yıl 2022, , 290 - 295, 27.09.2022
https://doi.org/10.18663/tjcl.1106642

Öz

Amaç: İntraserebral hemoraji (ISH), kronik hipertansiyon, amiloid anjipati, antikoagülanlar ve malformasyonlar risk faktörleri sonucunda oluşan, inmelerin bir türüdür. Primer ve spontan ISH, hemorajik inmelerin büyük bir kısmını oluşturur. ISH tedavisi, medikal ve cerrahi yaklaşımları kapsar. Bu çalışmada, cerrahi ve medikal tedaviler Glasgow Coma Scale (GCS) kullanılarak kıyaslnamıştır.
Hastalar ve Yöntem: Çalışmaya ISH’li 32 hasta katılmıştır. Tüm hastalarda tanı, kraniyal bilgisayarlı tomografi ve magnetik rezonans görüntüleme yöntemleri ile konulmuştur. Medikal tedavi 19 ve cerrahi tedavi 13 hastaya uygulanmıştır. İntrasebral hematomlu hastalarda, GCS skorları ilk kabulde ve tedavi sonrasında belirlenmiştir ve kıyaslanmıştır.
Bulgular: Çalışmada, 4’ü medikal tedavi alan ve 4’ü opere edilen toplam 8 hasta hayatını kaybetmiştir. Katılımcılar, lezyonun lokasyonuna göre, pre- ve post-tedavi GCS skorlarına göre incelenmiştir. Elde edilen veriler, GCS skorlarının, medikal ve cerrahi uygulama gruplarında, işlem öncesi ve sonrası istatiksel olarak anlamlılık olduğunu göstermiştir. Medikal olarak tedavi edilen hastaların GCS skorları, opere edilenlerinkine göre daha yüksek bulunmuştur. Tedaviler sonrası GCS skorları iki grup arasında yakın bulunmuş ve istatiksel bir fark tespit edilmemiştir.
Sonuç: Çalışma sonucunda elde edilen veriler, cerrahi tedavinin medikal tedaviye kıyasla daha iyi olmadığını göstermiştir.

Kaynakça

  • 1. Ziai WC, Carhuapoma JR. Intracerebral Hemorrhage. Continuum (Minneap Minn). 2018 Dec;24(6):1603–22.
  • 2. Elliott J, Smith M. The acute management of intracerebral hemorrhage: a clinical review. Anesth Analg. 2010 May;110(5):1419–27.
  • 3. Flower O, Smith M. The acute management of intracerebral hemorrhage. Curr Opin Crit Care. 2011 Apr;17(2):106–14.
  • 4. Poon MTC, Bell SM, Al-Shahi Salman R. Epidemiology of Intracerebral Haemorrhage. Front Neurol Neurosci. 2015;37:1–12.
  • 5. Rymer MM. Hemorrhagic stroke: intracerebral hemorrhage. Mo Med. 2011;108(1):50–4.
  • 6. Balami JS, Buchan AM. Complications of intracerebral haemorrhage. Lancet Neurol. 2012 Jan;11(1):101–18.
  • 7. Siddique MS, Mendelow AD. Surgical treatment of intracerebral haemorrhage. Br Med Bull. 2000;56(2):444–56.
  • 8. Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke. 1996 Aug;27(8):1304–5.
  • 9. Xi G, Keep RF, Hoff JT. Mechanisms of brain injury after intracerebral haemorrhage. Lancet Neurol. 2006 Jan;5(1):53–63. 10. Morgenstern LB, Demchuk AM, Kim DH, Frankowski RF, Grotta JC. Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage. Neurology [Internet]. 2001 May 22;56(10):1294 LP – 1299. Available from: http://n.neurology.org/content/56/10/1294.abstract
  • 11. Zuccarello M, Brott T, Derex L, Kothari R, Sauerbeck L, Tew J, et al. Early surgical treatment for supratentorial intracerebral hemorrhage: a randomized feasibility study. Stroke. 1999 Sep;30(9):1833–9.
  • 12. Morgenstern LB, Frankowski RF, Shedden P, Pasteur W, Grotta JC. Surgical treatment for intracerebral hemorrhage (STICH): a single-center, randomized clinical trial. Neurology. 1998 Nov;51(5):1359–63.
  • 13. Gregson BA, Rowan EN, Francis R, McNamee P, Boyers D, Mitchell P, et al. Surgical Trial In Traumatic intraCerebral Haemorrhage (STITCH): a randomised controlled trial of Early Surgery compared with Initial Conservative Treatment. Health Technol Assess. 2015 Sep;19(70):1–138.
  • 14. Mendelow AD, Unterberg A. Surgical treatment of intracerebral haemorrhage. Curr Opin Crit Care. 2007 Apr;13(2):169–74.
  • 15. Gurol ME, St Louis EK. Treatment of cerebellar masses. Curr Treat Options Neurol. 2008 Mar;10(2):138–50.
  • 16. Miller CM, Vespa PM, McArthur DL, Hirt D, Etchepare M. Frameless stereotactic aspiration and thrombolysis of deep intracerebral hemorrhage is associated with reduced levels of extracellular cerebral glutamate and unchanged lactate pyruvate ratios. Neurocrit Care. 2007;6(1):22–9.
  • 17. Vespa P, McArthur D, Miller C, O’Phelan K, Frazee J, Kidwell C, et al. Frameless stereotactic aspiration and thrombolysis of deep intracerebral hemorrhage is associated with reduction of hemorrhage volume and neurological improvement. Neurocrit Care. 2005;2(3):274–81.
  • 18. Morgan T, Zuccarello M, Narayan R, Keyl P, Lane K, Hanley D. Preliminary findings of the minimally-invasive surgery plus rtPA for intracerebral hemorrhage evacuation (MISTIE) clinical trial. Acta Neurochir Suppl. 2008;105:147–51.
  • 19. Murthy JMK, Chowdary GVS, Murthy TVRK, Bhasha PSA, Naryanan TJ. Decompressive craniectomy with clot evacuation in large hemispheric hypertensive intracerebral hemorrhage. Neurocrit Care. 2005;2(3):258–62.
  • 20. Mitchell P, Gregson BA, Vindlacheruvu RR, Mendelow AD. Surgical options in ICH including decompressive craniectomy. J Neurol Sci. 2007 Oct;261(1–2):89–98.
Toplam 19 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Özgün Makale
Yazarlar

Serhat Cömert

Yayımlanma Tarihi 27 Eylül 2022
Yayımlandığı Sayı Yıl 2022

Kaynak Göster

APA Cömert, S. (2022). Comparison of surgical and medical treatment in patients with spontaneous intracerebral hemorrhage. Turkish Journal of Clinics and Laboratory, 13(3), 290-295. https://doi.org/10.18663/tjcl.1106642
AMA Cömert S. Comparison of surgical and medical treatment in patients with spontaneous intracerebral hemorrhage. TJCL. Eylül 2022;13(3):290-295. doi:10.18663/tjcl.1106642
Chicago Cömert, Serhat. “Comparison of Surgical and Medical Treatment in Patients With Spontaneous Intracerebral Hemorrhage”. Turkish Journal of Clinics and Laboratory 13, sy. 3 (Eylül 2022): 290-95. https://doi.org/10.18663/tjcl.1106642.
EndNote Cömert S (01 Eylül 2022) Comparison of surgical and medical treatment in patients with spontaneous intracerebral hemorrhage. Turkish Journal of Clinics and Laboratory 13 3 290–295.
IEEE S. Cömert, “Comparison of surgical and medical treatment in patients with spontaneous intracerebral hemorrhage”, TJCL, c. 13, sy. 3, ss. 290–295, 2022, doi: 10.18663/tjcl.1106642.
ISNAD Cömert, Serhat. “Comparison of Surgical and Medical Treatment in Patients With Spontaneous Intracerebral Hemorrhage”. Turkish Journal of Clinics and Laboratory 13/3 (Eylül 2022), 290-295. https://doi.org/10.18663/tjcl.1106642.
JAMA Cömert S. Comparison of surgical and medical treatment in patients with spontaneous intracerebral hemorrhage. TJCL. 2022;13:290–295.
MLA Cömert, Serhat. “Comparison of Surgical and Medical Treatment in Patients With Spontaneous Intracerebral Hemorrhage”. Turkish Journal of Clinics and Laboratory, c. 13, sy. 3, 2022, ss. 290-5, doi:10.18663/tjcl.1106642.
Vancouver Cömert S. Comparison of surgical and medical treatment in patients with spontaneous intracerebral hemorrhage. TJCL. 2022;13(3):290-5.


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