| 1. |
- Fahlström, Andreas, et al.
(författare)
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Differences in neurosurgical treatment of intracerebral haemorrhage: a nation-wide observational study of 578 consecutive patients
- 2019
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Ingår i: Acta Neurochirurgica. - : Springer Science and Business Media LLC. - 0001-6268 .- 0942-0940. ; 161:5, s. 955-965
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundSupratentorial intracerebral haemorrhage (ICH) carries an excessive mortality and morbidity. Although surgical ICH treatment can be life-saving, the indications for surgery in larger cohorts of ICH patients are controversial and not well defined. We hypothesised that surgical indications vary substantially among neurosurgical centres in Sweden.ObjectiveIn this nation-wide retrospective observational study, differences in treatment strategies among all neurosurgical departments in Sweden were evaluated.MethodsPatient records, neuroimaging and clinical outcome focused on 30-day mortality were collected on each operated ICH patient treated at any of the six neurosurgical centres in Sweden from 1 January 2011 to 31 December 2015.ResultsIn total, 578 consecutive surgically treated ICH patients were evaluated. There was a similar incidence of surgical treatment among different neurosurgical catchment areas. Patient selection for surgery was similar among the centres in terms of patient age, pre-operative level of consciousness and co-morbidities, but differed in ICH volume, proportion of deep-seated vs. lobar ICH and pre-operative signs of herniation (p<.05). Post-operative patient management strategies, including the use of ICP-monitoring, CSF-drainage and mechanical ventilation, varied among centres (p<.05). The 30-day mortality ranged between 10 and 28%.ConclusionsAlthough indications for surgical treatment of ICH in the six Swedish neurosurgical centres were homogenous with regard to age and pre-operative level of consciousness, important differences in ICH volume, proportion of deep-seated haemorrhages and pre-operative signs of herniation were observed, and there was a substantial variability in post-operative management. The present results reflect the need for refined evidence-based guidelines for surgical management of ICH.
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| 2. |
- Tsitsopoulos, Parmenion P., et al.
(författare)
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Improved outcome of patients with severe thalamic hemorrhage treated with cerebrospinal fluid drainage and neurocritical care during 1990-1994 and 2005-2009
- 2013
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Ingår i: Acta Neurochirurgica. - : Springer Science and Business Media LLC. - 0001-6268 .- 0942-0940. ; 155:11, s. 2105-2113
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Tidskriftsartikel (refereegranskat)abstract
- Patients with thalamic hemorrhage, depressed level of consciousness and/or signs of elevated intracranial pressure may be treated with neurocritical care (NCC) and external ventricular drainage (EVD) for release of cerebrospinal fluid. Forty-three patients with thalamic hemorrhage treated with NCC from 1990 to 1994 (n = 21) and from 2005-2009 (n = 22) were evaluated. Outcome was assessed using the Glasgow Coma Scale (GCS) score at discharge from our unit and the modified Rankin Scale (mRS) for long-term outcome. Patients' age was 59.5 +/- 7 years in 1990-1994, and 58.2 +/- 9 years in 2005-2009. The median (25th and 75th percentile) GCS score on admission for the two time periods was 9 (6-12) and 9 (4-14), respectively. Long-term follow-up was assessed at a mean of 37.1 (range 19-65) months after disease onset for the 1990-1994 cohort and at 37.4 (range 14-58) months for the 2005-2009 cohort. Compared to patients from 1990 to 1994, patients from 2005 to 2009 had a significantly better outcome (median mRS [25th and 75th percentile]: 5 [4-6] vs. 4 [2-4.5]; p < 0.01). Most patients (13/21, 62 %) treated from 1990 to 1994 had unchanged or lower GCS scores during their NCC stay in contrast to 7/22 (32 %) from 2005 to 2009. At the last follow-up, 13/21 (62 %) patients from 1990 to 1994 were dead in comparison to 4/21 (19 %) from 2005 to 2009 (p < 0.05). Negative prognostic factors were the 120 h post-admission GCS score in the 1990-1994 patient cohort (p = 0.07) and high age in the recent cohort (p = 0.04). Patients with thalamic hemorrhage and depressed level of consciousness on admission had a worse outcome in the early 1990s compared with the late 2000s, which may at least be partially attributed to refined neurocritical care.
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| 3. |
- Tsitsopoulos, Parmenion P., et al.
(författare)
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Prognostic factors and long-term outcome following surgical treatment of 76 patients with spontaneous cerebellar haematoma
- 2012
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Ingår i: Acta Neurochirurgica. - : Springer Science and Business Media LLC. - 0001-6268 .- 0942-0940. ; 154:7, s. 1189-1195
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Tidskriftsartikel (refereegranskat)abstract
- Although large spontaneous cerebellar haematomas are associated with high mortality, surgical treatment may be life-saving. We evaluated the clinical outcome and identified prognostic factors in 76 patients with cerebellar haematoma, all treated with suboccipital decompression, haematoma evacuation and external ventricular drainage. Patients receiving surgical and neurocritical care treatment within a 10-year period were included. Level of consciousness during hospitalisation was evaluated using the Glasgow Coma Scale (GCS) score. Outcome was assessed with the modified Rankin Scale (mRS). Predictive prognostic factors were analysed using univariate and multivariate regression analysis. Prior to surgery, the median GCS score was 8.6 (range 3-13). At discharge it had improved to 12.1 (4-15) (p < 0.05). The median long-term follow-up period was 70.5 (22-124) months. At 6 months post-surgery, 19 patients were dead and 28 patients had a good outcome (mRS < 3). In the long term (70.5 months), 31 patients (41.9 %) were dead and the outcome was good in 27 patients (37.8 %). Although approximately 25 % of patients > 65 years old had a favourable outcome, age was the strongest negative predictor for a bad outcome at 6 months and long term (p = 0.02 and p = 0.01, respectively). The level of consciousness before surgery did not influence the 6-month or long-term outcome (p = 0.39 and p = 0.65, respectively). Although mortality was high, significant complications from the treatment were rare and most survivors had a good outcome, reaching functional independence. High age was the strongest prognostic factor for an unfavourable outcome.
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| 4. |
- Tsitsopoulos, Parmenion P., et al.
(författare)
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Surgical treatment of patients with unilateral cerebellar infarcts : clinical outcome and prognostic factors
- 2011
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Ingår i: Acta Neurochirurgica. - : Springer Science and Business Media LLC. - 0001-6268 .- 0942-0940. ; 153:10, s. 2075-2083
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Tidskriftsartikel (refereegranskat)abstract
- There are limited data on the long-term outcome and on factors influencing the prognosis in patients with cerebellar infarcts treated with surgical decompression. Thirty-two patients (age 64.3 +/- 9.9 years) with expansive unilateral cerebellar infarcts were retrospectively evaluated. All patients were treated with ventriculostomy, suboccipital decompressive craniectomy and removal of the necrotic tissue. The Glasgow Coma Scale (GCS) and the Reaction Level Scale (RLS) scores evaluated the level of consciousness during hospitalization, while the modified Rankin Scale (mRS) was used for the 6-month and long-term outcome. Predicting factors were analyzed using a univariate logistic regression model. The median time from ictus to surgery was 48.4 h (range 8-120 h). Before surgery, the median GCS score was 9 (3-13). At discharge, the GCS score improved to 13.6 (7-15) (p < 0.05 compared to preoperative scores). At the long-term follow-up (median 67.5 months), ten patients were dead, and 77% of survivors had a good outcome (mRS score of a parts per thousand currency sign2). The number of days on a ventilator and the GCS score prior to surgery and at discharge were strong predictors of clinical outcome (p < 0.05), although one third of patients with a GCS a parts per thousand currency signaEuro parts per thousand 8 at the time of surgery had a good long-term outcome. In patients a parts per thousand yen70 years old, 50% had a good long-term outcome, and advanced age was not associated with a bad result (p > 0.05). Our results imply that surgical evacuation of significant cerebellar infarctions may be considered also in patients with advanced age and/or a decreased level of consciousness.
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