Management of spontaneous intracerebral hemorrhage: a retrospective comparison of four treatment strategies - 26/07/26
Highlights |
• | Real-world comparison of four treatment strategies for spontaneous ICH. |
• | Surgery was mainly performed in patients with severe presentations. |
• | No functional benefit of surgery was observed at 6 months. |
• | Age, admission GCS, and hematoma volume predicted poor outcome. |
• | Initial severity outweighed treatment strategy in determining prognosis. |
Abstract |
Background |
Spontaneous intracerebral hemorrhage (ICH) is a severe neurological emergency with high morbidity and mortality. Optimal management remains debated.
Methods |
We retrospectively included consecutive patients with spontaneous ICH at Reims University Hospital (Jan 2020-Aug 2023). Secondary ICH and incomplete data were excluded. Patients were classified into medical management, surgical evacuation, external ventricular drainage, or surgery plus EVD. Primary outcome was 6-month functional status (mRS 0−3 favorable). Secondary outcomes included mortality, ventilation duration, length of stay, intracranial hypertension, and surgical complications.
Results |
Among 289 patients (median age 72 years; 57% male), 253 (87%) received medical management, 15 (5%) EVD, 13 (4.5%) surgery, and 8 (3%) combined treatment. Surgical patients had more severe disease: lower GCS, larger hematomas, anisocoria, and higher ventilation rates. Overall 6-month mortality was 38%, with no significant differences between groups. Poor outcome (mRS >3) occurred in 58%, more frequent in surgical patients. Multivariate analysis identified older age, lower GCS, and larger hematoma volume as independent predictors. Surgery did not improve outcomes even in hematomas ≥30 mL.
Conclusion |
In this cohort, surgery was reserved for the most severe ICH but did not improve 6-month mortality or functional outcomes. Prognosis depended mainly on baseline severity and hematoma characteristics. Careful patient selection and prospective studies are needed to refine surgical indications in spontaneous ICH.
Le texte complet de cet article est disponible en PDF.Keywords : Intracerebral hemorrhage, Neurosurgery, External ventricular drainage, Intensive care, Modified rankin scale
Abbreviations : AHA, ASA, AVM, BMI, BP, CT, DC, EANS, ESO, EVD, GCS, HBP, ICH, ICP, ICU, IVH, MID, mRS, PCC, STROBE
Plan
Vol 72 - N° 5
Article 101858- septembre 2026 Retour au numéro
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