Spontaneous Intracerebral Hematoma Operated in Two Neurosurgical Centers in Madagascar
Rasolonjatovo Emilson Charles1*, Andrianaivo Radotina Tony1,
Rakotovao Tsiky Ketsia1, Rakotondraibe Willy Francis3,
Ratovondrainy Willy2, Rabarijaona Mamiarisoa4 and Andriamamonjy Clément1
1CHUJRA Antananarivo Madagascar, Africa
2C,ENHOSOA Antananarivo Madagascar, Africa
3CHU PZAGA Mahajanga Madagascar, Africa
4CHU Tambohobe Fianarantsoa Madagascar, Africa
*Corresponding Author: Rasolonjatovo Emilson Charles, CHUJRA Antananarivo Madagascar, Africa.
January 12, 2023; Published: January 30, 2022
Primary spontaneous intra-parenchymal haematomas are associated with high morbidity and mortality and are rarely operated on. The aim of this study is to report the characteristics of primary intra-parenchymal haematomas operated in two neurosurgical centres in Madagascar.
This is a retrospective descriptive and analytical transversal study over a period of 5 years. We collected 32 patient files. The average age was 51.6 years. The sex ratio was 1.66. All patients were hypertensive. The Glasgow score was between 8 and 14 in 56.3%. Motor deficit was identified in 84.4%. Brain MRI was performed in 6.2% and no arteriography was performed. The haematoma was sustentorial in 84.4% and subtentorial in 15.6%. Hydrocephalus was found in 31.2%. The volume of the haematoma was greater than 30 ml in 75%. For cerebellar haematomas, craniectomy with evacuation of the haematoma after a CSF shunt is used. Craniotomy with evacuation of the hematoma for sustentorial hematoma. The mortality rate was 40.6%. The mRS score was 0-2 at 3 months in 29.4%. Preoperative GCS greater than 8 was associated with low mortality (p = 0.001).
There is still no consensus on the surgical indication. The decision for surgery must be considered on a case-by-case basis.
Keywords: Cerebral Haemorrhage; Hypertension; Surgery; X-Ray Computed
- Decavel P., et al. “Hématomes intracérébraux spontanés”. EMC - Neurologie1 (2010): 1‑10.
- Mendelow AD., et al. “Early Surgery versus Initial Conservative Treatment in Patients with Spontaneous Supratentorial Intracerebral Haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): A Randomised Trial”. Lancet 365 (2005): 11.
- Bejot Y., et al. “Prise en charge des accidents vasculaires cérébraux en urgence”. EMC - Médecine d ’urgence 1 (2010): 1‑21.
- Grillo P., et al. “Accident vasculaire cérébral hémorragique : nouveautés sur la prise en charge”. Annales Françaises d’Anesthésie et de Réanimation8 (2006): 868‑873.
- Van A., et al. “Incidence, Case Fatality, and Functional Outcome of Intracerebral Haemorrhage over Time, According to Age, Sex, and Ethnic Origin: A Systematic Review and Meta-Analysis”. The Lancet Neurology2 (2010): 167‑176.
- Sun., et al. “The Effect of Mannitol in the Early Stage of Supratentorial Hypertensive Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis”. World Neurosurgery 124 (2019): 386‑396.
- Dastur CK., et al. “Current Management of Spontaneous Intracerebral Haemorrhage”. BMJ1 (2017): 21‑29.
- Sondag., et al. “Neurosurgical Intervention for Supratentorial Intracerebral Hemorrhage”. Annals of Neurology2 (2020): 239‑250.
- De Oliveira AL. “Surgery for Spontaneous Intracerebral Hemorrhage”. Critical Care1 (2020): 45.
- Kirollos RW., et al. “Management of Spontaneous Cerebellar Hematomas: A Prospective Treatment Protocol”. Neurosurgery6 (2001): 10.
- Amar AP. “Controversies in the Neurosurgical Management of Cerebellar Hemorrhage and Infarction”. Neurosurgical Focus 4 (2012): E1.
- Flaherty ML., et al. “Surgery for Intracerebral Hemorrhage: Moving Forward or Making Circles?” Stroke 10 (2013): 2953‑2954.
- Gregson BA., et al. “Update on the Surgical Trial in Lobar Intracerebral Haemorrhage (STICH II): Statistical Analysis Plan”. Trials1 (2012): 222.
- Wong JM., et al. “Patterns in Neurosurgical Adverse Events: Open Cerebrovascular Neurosurgery”. Neurosurgical Focus 5 (2012): E15.
- Lee BY., et al. “Association between Volume of Surgery for Acute Hemorrhagic Stroke and Mortality”. Medicine35 (2018): e12105.
- Mendelow AD., et al. “Early Surgery versus Initial Conservative Treatment in Patients with Spontaneous Supratentorial Lobar Intracerebral Haematomas (STICH II): A Randomised Trial”. The Lancet 9890 (2013): 397‑408.
- Vitt JR., et al. “Minimally Invasive Surgery for Intracerebral Hemorrhage”. Current Opinion in Critical Care (2020): 1.
- Shaaban A., et al. “Retrospective Analysis of the Surgical Management of Spontaneous Supratentorial Intracerebral Hemorrhage: A Single-Center Study”. Qatar Medical Journal3 (2021): 1-13.