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From the Departments of Neurology (Drs. Morgenstern, Pasteur, and Grotta) and Neurosurgery (Dr. Shedden), The University of Texas Medical School at Houston; and the Epidemiology Research Center (Dr. Morgenstern) and Department of Biometry (Dr. Frankowski), The University of Texas School of Public Health, Houston, TX.
Address correspondence and reprint requests to Dr. Lewis B. Morgenstern, Department of Neurology, University of Texas at Houston, 6431 Fannin, Room 7.044, Houston, TX 77030.
Objective: To perform a single-center pilot investigation of early hematoma removal in patients with intracerebral hemorrhage (ICH).
Background: Considerable debate remains regarding the utility of surgical clot evacuation for ICH.
Methods: This was a prospective trial of open craniotomy within 12 hours of ICH symptom onset versus best medical therapy. Patients were eligible if they had a nontraumatic ICH >9 mL with significant neurologic impairment and were prepared for surgery within 12 hours of symptom onset. The study included a prospective registry of patients and a randomized trial.
Results: The registry group included 34 medical and seven surgical patients. The surgical group had larger hemorrhages (median, 96 mL) and a lower Glasgow Coma Scale (GCS) score (median, 10) compared with the medical group (33 mL; GCS score, 13). Six-month mortality was less in the medical group (36%) compared with the surgical group (54%). In the randomized series, median ICH volumes were similar in the surgical group (n = 17; 49 mL) compared with the medical group (n = 17; 44 mL). Median GCS score was also similar (medical, 10; surgical, 11). Mortality was lower in the surgical group (6%) compared with the medical group (24%) at 1 month, but similar at 6 months (surgical group, 17%; medical group, 24%).
Conclusion: A trial of early surgery for ICH is feasible. This study represents the largest prospective, randomized series of surgery for ICH. A modest early mortality benefit for surgery is possible, but long-term benefit for surgery was not established in this single-center pilot investigation.
Supported by an American Heart Association Clinician-Scientist Award (L.B.M.).
Received March 16, 1998. Accepted in final form July 2, 1998.
Deceased.
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