Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage

Neurology. 2001 May 22;56(10):1294-9. doi: 10.1212/wnl.56.10.1294.


Background: A modest benefit was previously demonstrated for hematoma evacuation within 12 hours of intracerebral hemorrhage onset. Perhaps surgery within 4 hours would further improve outcome.

Methods: Adult patients with spontaneous supratentorial intracerebral hemorrhage were prospectively enrolled. Craniotomy and clot evacuation were commenced within 4 hours of symptom onset in all cases. Mortality and functional outcome were assessed at 6 months. This group of patients was compared with patients treated within 12 hours of symptom onset using the same surgical and medical protocols.

Results: The study was stopped after a planned interim analysis of 11 patients in the 4-hour surgery arm. Median time to surgery was 180 minutes; median hematoma volume was 40 mL; median baseline NIH Stroke Scale score was 19 and Glasgow Coma Scale score was 12. Six-month mortality was 36% and median Barthel score was 75 in survivors. Postoperative rebleeding occurred in four patients, three of whom died. A relationship between postoperative rebleeding and mortality was apparent (p = 0.03). Rebleeding occurred in 40% of the patients treated within 4 hours, compared with 12% of the patients treated within 12 hours (p = 0.11). There was a clear correlation between improved outcome and smaller postsurgical hematoma volume (p = 0.04).

Conclusions: Surgical hematoma evacuation within 4 hours of symptom onset is complicated by rebleeding, indicating difficulty with hemostasis. Maximum removal of blood remains a predictor of good outcome.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brain / diagnostic imaging
  • Brain / physiopathology
  • Brain / surgery
  • Cerebral Arteries / pathology
  • Cerebral Arteries / physiopathology
  • Cerebral Arteries / surgery
  • Cerebral Hemorrhage / diagnostic imaging
  • Cerebral Hemorrhage / physiopathology*
  • Cerebral Hemorrhage / surgery*
  • Craniotomy / adverse effects*
  • Female
  • Hematoma / diagnostic imaging
  • Hematoma / physiopathology
  • Hematoma / surgery
  • Humans
  • Male
  • Middle Aged
  • Pilot Projects
  • Postoperative Hemorrhage / diagnostic imaging
  • Postoperative Hemorrhage / prevention & control*
  • Prospective Studies
  • Survival Rate
  • Tomography, X-Ray Computed
  • Treatment Outcome