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Comparative Studies | Neuroscience | India | Volume 13 Issue 11, November 2024 | Rating: 5.4 / 10
Comparative Study on Decompressive Craniectomy with Clot Evacuation Versus Medical Management in Hypertensive Intracerebral Hemorrhage: An Institutional Cohort Study
Dr. Sheikh Khurshid Alam Ali | Dr. G M Niban [2] | Dr. R R Ramkumar [2]
Abstract: Introduction: Intracerebral hemorrhage (ICH) is a critical form of stroke, especially prevalent in specific demographics, resulting in significant morbidity and mortality. Decompressive craniectomy with hematoma evacuation is proposed to alleviate intracranial pressure, but its efficacy relative to conservative management remains controversial. Ongoing research investigates minimally invasive interventions, yet clinical guidelines vary, and long - term prognostic data is insufficient. This study aims to evaluate outcomes associated with neurosurgical versus medical management in hypertensive ICH cases. Methods: This retrospective cohort study at Kanyakumari Government Medical College and Hospital analyzed 105 adult patients with hypertensive intracerebral hemorrhage (ICH) from July 2022 to June 2024. Participants were divided into surgical and medical management groups, with outcomes assessed for mortality and functional outcome. Data were analyzed to identify predictive factors for surgery and mortality, considering a significance level of p < 0.05. Limitations included potential selection bias and single - centre design. The study aims to improve understanding of treatment efficacy for hypertensive ICH. Results: The study involved 105 surgical patients with intracerebral hemorrhage (ICH), of whom 50 underwent decompressive craniectomy. Most ICH cases were in the gangliocapsular and lobar regions, with similar male - to - female ratios and no significant differences in risk factors. Predictive factors for surgery included age, ICH volume, and midline shift, while mortality was linked to ICH volume and prior ICH history. Discussion: The study found no significant improvement in surgical outcomes for spontaneous supracentimetric intracerebral hemorrhage (ICH) compared to conservative management, aligning with STICH II results. Despite a minor reduction in mortality, factors like limited healthcare access in India impacted outcomes. Many patients were admitted to non - specialized neurosurgery departments instead of dedicated stroke units, essential for optimal care. While surgery was linked to longer survival, it also resulted in higher complication rates and prolonged hospital stays. Conclusion: Our study found no overall benefit of surgery for spontaneous supracentimetric ICH compared to conservative care. Surgical patients were generally younger and had more severe conditions. Further research is needed to refine patient selection and standardize procedures in stroke centres.
Keywords: Intracerebral hemorrhage, Decompressive craniectomy and clot evacuation, Supracentimetric ICH
Edition: Volume 13 Issue 11, November 2024,
Pages: 117 - 123