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논문 기본 정보

자료유형
학술저널
저자정보
Kim, Hui-Tae (Department of Neurosurgery, Chonbuk National University Hospital and Medical School) Lee, Jong-Myong (Department of Neurosurgery, Chonbuk National University Hospital and Medical School) Koh, Eun-Jeong (Department of Neurosurgery, Chonbuk National University Hospital and Medical School) Choi, Ha-Young (Department of Neurosurgery, Chonbuk National University Hospital and Medical School)
저널정보
대한신경외과학회 대한신경외과학회지 대한신경외과학회지 제58권 제4호
발행연도
2015.1
수록면
309 - 315 (7page)

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Objective : An advantage of surgical treatment over conservative treatment of spontaneous intracerebral hemorrhage (ICH) is controversial. Recent reports suggest that contrast extravasations on CT angiography (CTA) might serve as a crucial predictor of hematoma expansion and mortality. The purpose of this study was aimed at investigating the efficacy of surgical treatment in patients with spot sign positive ICH. Methods : We used our institutional medical data search system to identify all adult patients who admitted for treatment of ICH between January 1, 2007 and January 31, 2012. Patients were classified two groups into a surgical group (n=27) and a conservative treatment group (n=28). Admission criteria were the following: age 20-79 years, spontaneous supratentorial ICH, Glasgow Coma Score Ranging from 9 to 14, ICH volume ${\geq}20mL$, and treatment within 24 hours. Results : Fifty-five patients were analyzed. There was no significant difference in the ICU stay between the conservative treatment group ($7.36{\pm}3.66days$) and the surgical treatment group ($6.93{\pm}2.20days$; p=0.950). There was a significant difference in the in-hospital stay between the conservative treatment group ($13.93{\pm}8.87days$) and the surgical treatment group ($20.33{\pm}6.37days$; p=0.001). Overall mortality at day 90 after ICH was 36.4%; this included 16 of 28 patients (57.1%) in the conservative group and 4 of 27 patients (14.8%) in the surgical group. In univariate analysis, there was a positive effect of the surgical treatment in reducing mortality at 90 days (p=0.002), Glasgow Outcome Scale (GOS) at 90-day (p=0.006), and modified Rankin Scale (mRS) at 90-day (p=0.023). In multivariate logistic analysis, there was a significant difference in mortality (odds ratio, 0.211; 95% confidence interval, 0.049-0.906; p=0.036) between the groups at 90-day follow-up. However, there was no significant difference in GOS (odds ratio, 0.371; 95% confidence interval, 0.031-4.446; p=0.434) and mRS (odds ratio, 1.041; 95% confidence interval, 0.086-12.637; p=0.975) between the groups at 90-day follow-up. Conclusion : In this study of surgical treatment of supratentorial ICH in patients with spot sign positive in CTA was associated with less mortality despite of long duration of in-hospital stay. We failed to show that clinical outcome benefit of surgical treatment compared with conservative treatment in patients with spot sign positive ICH.
#Intracerebral hemorrhage #Spot sign #Surgery #Conservative treatment

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참고문헌 (31)

참고문헌 신청
Anderson CS. / 2008 / Intensive blood pressure reduction in acute cerebral haemorrhage trial(INTERACT) : a randomised pilot trial / Lancet Neurol 7:391~399 google schola Auer LM. / 1989 / Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma : a randomized study / J Neurosurg 70:530~535 google schola Batjer HH. / 1990 / Failure of surgery to improve outcome in hypertensive putaminal hemorrhage. A prospective randomized trial / Arch Neurol 47:1103~1106 google schola Broderick JP. / 1993 / Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality / Stroke 24:987~993 google schola Brott T. / 1997 / Early hemorrhage growth in patients with intracerebral hemorrhage / Stroke 28:1~5 google schola

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