Husam S. Mourad¹, Ayman A. Enab², Ahmed M. Abdelalim¹

Departments of Neurology¹, Neurosurgery ², Cairo University; Egypt

Background: Spontaneous supratentorial intracerebral hemorrhage (ICH) is one of the most severe types of stroke. The decision about whether and when to surgically remove ICH remains controversial. Early surgery to limit the mechanical compression of brain and the toxic effects of blood may limit injury. Objective:  To investigate the early outcome and effectiveness of surgery as compared with conservative medical treatment in supratentorial intracerebral hemorrhage. Methods: Forty Patients with supratentorial spontaneous ICH was assigned to surgical or best medical treatment. Twenty patients underwent surgical evacuation while twenty were received conservative medical therapy. A history and examination, including an assessment by Glasgow Coma Scale (GCS) and of the neurological status by the National Institutes of Health Stroke Scale (NIHSS), were obtained at the time of admission and after one month. Glasgow outcome scale (GOS) was performed after one month. Results: There were no statistically significant differences in GOS, GCS or NIHSS after one month of treatment (p>0.05). There was 15% mortality each group with no statistically significant difference (p>0.05). Patients with baseline GCS ≥9 had a better final GCS (p=0.035) in the conservative compared to surgical groups but no significant difference in final NIHSS or GOS (p>0.05). Conclusion: we conclude that surgical evacuation of supratentorial intracerebral has a limited benefit compared to conservative medical treatment. It may be considered in large hematomas (>80cc) with moderate impairment of conscious level. Initial GCS is better than NIHSS in the prediction of outcome and mortality.  [Egypt J Neurol Psychiat Neurosurg.  2011; 48(1): 85-92]

Key Words: Spontaneous intracerebral hemorrhage- surgical treatment - conservative management – GCS – GOS- NIHSS.