Factors affecting the outcome of surgical evacuation of spontaneous deep intra cerebral bleeds.

Background: Patients with spontaneous deep intra cerebral bleeds have a poor outcome where in the mortality range is from 32% to 50% and with only 10% being functionally independent after 30 days. The indications for surgical evacuation of spontaneous deep intra cerebral bleeds are poorly defined. The purpose of this study is to determine the factors associated with improved survival rates at 30 days following evacuation of deep intracerebral bleeds.

Patients And Methods: Patients treated with a mini frontotemporal craniectomy and evacuation of the hematoma between August 2008 and July 2010 were the subjects of the study. The factors associated with 30-day survival in relation to Age, the severity of the illness (calculated by GCS score), volume of the bleed (calculated by axbxc/2 method), timing of surgery, associated co-morbid illness (hypertension, diabetes mellitus) was evaluated.

Results: Of the 55 patients entered in the study, 47% (n = 26) were alive at 30 days and 53% died (n = 29). Factors associated with survival following surgery were age less than 60 years, male gender, right-sided bleeds, GCS scores of ≥ 8/15, volume of bleeds less than 70 ml, and early surgery within 24 h following the ictus. Factors with no impact on surgical outcome include the presence of comorbid illness (hypertension, diabetes mellitus), (P = 0.247).

Conclusion: Where surgical evacuation of spontaneous deep intracerebral bleeds is done, the earlier the surgery, the better the survival at 30 days.