Prognostic Factors for Surgical Management of Large Hypertensive Basal Ganglionic Haemorrhage

Prognostic Factors for Surgical Management of Large Hypertensive Basal Ganglionic Haemorrhage

The aim of this study is to present current and comprehensive recommendations for surgical treatment of this hematoma and to determine the factors that may improve the survival rate

Spontaneous intracerebral hemorrhage is a common, mostly deadly stroke subtype and accounts for 10% to 15% of all strokes.

It's associated with a higher mortality rate (44% after 30 days) than either ischemic stroke or subarachnoid hemorrhage Up to 75% of the long term survivors are often suffering significant disability and only 12% to 39% of the survivors have favourable neurological functions recovered Rapid diagnosis and attentive management of patients is crucial because early deterioration is common Neurosurgical treatment for ICH has been discussed in recent multicentric studies, but no definitive answer of its utility has emerged.

Improved surgical techniques , neuroimaging, neuroanesthesia and perioperative monitoring and care have all led to improved outcomes from surgery

Inclusion Criteria:

• 1) patients aged between 15 and 60 years old ( elderly people>60 years were excluded since their strokes weren't routinely examined by CT scan in the emergency ward, however, in children<15 years old was due mostly to vascular malformations 2) CT scan showed basal ganglionic haemorrhage, with or without intraventricular extension within 24 hr post ictus 3) hematoma volume was 30 ml or above 4) Glasgow Coma Scale scores more than or equal 5 and stable vital signs

Exclusion Criteria:

• 1) intracerebral hemorrhage was caused by secondary factors e.g ( vascular malformations or head trauma) 2) GCS less than 5 or multiple intracranial hemorrhage 3) associated visceral disease e.g hepatic or renal or clotting disorder 4) patients with preexisting neurological deficit e.g previous intracerebral hemorrhage or infarction