6-Month Functional Outcome in Supratentorial Hemorrhage Surgery
Journal name: The Malaysian Journal of Medical Sciences
Original article title: Functional Outcome at 6 Months in Surgical Treatment of Spontaneous Supratentorial Intracerebral Haemorrhage
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Abdul Rahman Izaini Ghani, John Tharakan Kalappurakkal John, Zamzuri Idris, Mazira Mohamad Ghazali, Nur-Leem Murshid, Kamarul Imran Musa
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: Functional Outcome at 6 Months in Surgical Treatment of Spontaneous Supratentorial Intracerebral Haemorrhage
Year: 2008
Copyright (license): CC BY 4.0
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Summary of article contents:
Introduction
Intracerebral hemorrhage (ICH) remains a significant cause of morbidity and mortality, with limited advancements in treatment options over the years. This prospective cohort study conducted in Malaysia aimed to evaluate the effectiveness of surgical interventions for patients with spontaneous supratentorial ICH and to identify factors influencing functional outcomes. The study involved 36 patients and utilized clinical, radiological, biochemical, and treatment factors to examine their contributions to patient prognosis at a six-month follow-up, employing the Glasgow Outcome Scale (GOS) for assessment. The results indicated a high incidence of poor outcomes and mortality among the study population.
Importance of Midline Shift
One of the critical findings of the study was the significant correlation between midline shift and functional outcomes in patients with ICH. Univariate analysis revealed a p-value of 0.013 for midline shift, establishing it as a vital predictor of poor outcomes, while multivariate analysis confirmed it as the only significant independent predictor, with patients showing midline shift greater than 5 mm having approximately 21 times higher odds of experiencing unfavorable outcomes (adjusted odds ratio of 20.8, 95% CI 1.90 – 227.26). This reinforces the understanding that midline shift serves as an essential indicator of mass effect and intracranial pressure, highlighting its role in clinical assessment and surgical decision-making.
Conclusion
Despite the implementation of surgical interventions aimed at addressing spontaneous supratentorial ICH, the outcomes of the study revealed that only a minority of patients (14%) achieved a favorable recovery, while a significant 86% faced poor outcomes. This emphasizes the complex nature of ICH management, where factors such as midline shift play a pivotal role in prognosis. Although the study aimed to explore the implications of invasive monitoring techniques such as regional cortical cerebral blood flow and microdialysis, the limited benefits observed from surgical intervention highlight the need for further research and improved strategies in the treatment of ICH to enhance patient survival and recovery.
FAQ section (important questions/answers):
What was the main objective of the study on spontaneous ICH?
The study aimed to evaluate the role of surgery in spontaneous supratentorial intracerebral hemorrhage and identify clinical, radiological, biochemical, and treatment factors that influence functional outcomes post-surgery.
What surgical interventions were performed on the patients in the study?
Patients underwent either craniotomy or decompressive craniectomy for hematoma evacuation, along with ventriculostomy for intracranial pressure monitoring and regional cortical cerebral blood flow (rCoBF) monitoring.
What were the significant predictors of functional outcomes identified in the study?
The study identified midline shift and the mean lactate:pyruvate ratio as significant predictors of functional outcome, with midline shift being the sole independent predictor.
What were the outcomes for patients six months post-surgery?
At six months, 86% of patients experienced poor outcomes, while 14% had favorable outcomes. The mortality rate at six months was 55%.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “6-Month Functional Outcome in Supratentorial Hemorrhage Surgery”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Study (Studying):
The term 'study' refers to the prospective cohort study conducted to evaluate surgical interventions for spontaneous supratentorial intracerebral hemorrhage. This study aimed to identify predictors of functional outcomes in patients and assess the efficacy of surgical techniques and monitoring methods in managing this severe neurological condition.
2) Blood:
In the context of this study, 'blood' primarily pertains to intracerebral hemorrhage, where blood leaks into the brain tissue, leading to serious complications. The analysis includes parameters like regional cerebral blood flow and lactate:pyruvate ratios, which indicate the metabolic state and impact brain health and recovery.
3) Pur (Pūr):
The term 'poor' describes the unfavorable outcomes categorized by the Glasgow Outcome Scale at the 6-month follow-up. In this study, 86% of the patients experienced poor outcomes (GOS I–III), highlighting the challenges and limited effectiveness of surgical interventions for spontaneous intracerebral hemorrhage in improving survival and quality of life.
4) Coma:
In this study, 'coma' relates to the Glasgow Coma Score (GCS) used to assess the level of consciousness in patients with spontaneous intracerebral hemorrhage. The initial GCS scores ranged from 5 to 9, indicating varying degrees of coma, which correlates with outcomes and potential recovery post-surgery.
5) Table:
The term 'table' refers to the structured presentation of data showcasing baseline characteristics, analysis results, and statistical outcomes of the study. This organization allows for quick reference and comparison of significant variables, enhancing the understanding of factors influencing patient outcomes in hemorrhagic events.
6) Post:
Here, 'post' signifies the period following surgical intervention in patients. The study tracked functional outcomes at 1, 3, and 6 months post-operatively, allowing for evaluation of recovery and the effectiveness of treatment strategies in addressing the severe implications of spontaneous intracerebral hemorrhage.
7) Measurement:
In the context of this study, 'measurement' refers to the quantification of various parameters such as regional cerebral blood flow, intracranial pressure, and lactate:pyruvate ratios during patient monitoring. Accurate measurements are crucial for assessing the brain’s metabolic state and predicting functional outcomes after hemorrhagic events.
8) Disease:
The term 'disease' relates to cerebral hemorrhage, a significant medical condition investigated in this study. The focus is on spontaneous supratentorial intracerebral hemorrhage, characterized by bleeding within the brain, leading to high morbidity and mortality, emphasizing the need for effective surgical and medical treatments.
9) Swelling:
In this study, 'swelling' refers to the brain edema that often accompanies intracerebral hemorrhage. It can lead to increased intracranial pressure and necessitate interventions such as decompressive craniectomy. Monitoring and managing swelling are vital for improving outcomes and preventing secondary brain injury.
10) Relative:
The term 'relative' is relevant in the study context, especially concerning the consent obtained from patient relatives for participation. Family members play an essential role in decision-making and understanding the prognosis, particularly in critical conditions like spontaneous intracerebral hemorrhage, emphasizing the importance of communication.
11) Channel:
In the study, 'channel' is likely associated with the method used to monitor cerebral blood flow and chemical changes in the brain. The regional cerebral blood flow measurement through a thermal diffusion flowmetry sensor reflects the physiological state of the brain, aiding in prognosis.
12) Meeting:
Here, 'meeting' alludes to the consultations with family members or caregivers when patients are unable to attend follow-up assessments due to disabilities. These meetings are crucial for gathering additional information regarding the patient's functional status and family perspectives on the recovery process.
13) Surface:
The term 'surface' could refer to the surgical approach involving the gyral surface of the brain for monitoring regional cortical blood flow. Assessing the brain's surface is essential for surgical interventions to minimize trauma and enhance recovery while ensuring accurate placement of monitoring devices.
14) Family:
In the context of this study, 'family' is significant as they are integral to the care and support of the patients. Family members often provide essential information during assessments and help understand the patient's condition, prognosis, and the emotional impact of poor functional outcomes.
15) Maira (Mairā):
The mention of 'Maira' likely refers to a researcher or author associated with previous studies on decompressive craniectomy for intracerebral hemorrhage. Citing Maira's work provides a reference for comparative analysis and contextualizes findings related to surgical outcomes in patients with similar conditions.
16) Male (Mālē):
In this study, the term 'male' helps categorize the gender distribution of the patient cohort, with 52.8% identified as male. This demographic detail is significant for analyzing potential differences in outcomes based on sex and understanding any physiologic variances that may influence recovery.
17) Line:
The term 'line' may refer to the orbitomeatal line used in CT scans for obtaining precise imaging of brain structures. Accurate imaging is essential for diagnosing hematoma locations and assessing the extent of hemorrhagic events to plan appropriate surgical interventions.
18) Hand:
In the study context, 'hand' can metaphorically refer to the need for careful surgical technique and skilled handling during interventions. The surgical hand movements and approaches largely influence the success of hematoma evacuation and the overall outcomes for patients suffering from intracerebral hemorrhage.
Other Science Concepts:
Discover the significance of concepts within the article: ‘6-Month Functional Outcome in Supratentorial Hemorrhage Surgery’. Further sources in the context of Science might help you critically compare this page with similair documents:
Surgical treatment, Hemiplegia, Craniotomy, Neurons, Multivariate analysis, Morbidity and Mortality, Mortality Rate, Clinical Follow-Up, Functional outcome, Age distribution, Prospective cohort study, Biochemical factors, Intensive care unit, Hospital stay, Intracerebral hemorrhage, Lactate: pyruvate ratio, Binary logistic regression analysis, GC, Glasgow coma score, Binary Logistic Regression, Intraventricular hemorrhage, Univariate analysis, CT Brain, Poor outcome, Mass effect, Intracranial pressure monitoring, Good outcome, Clinical factors, Intracerebral haemorrhage, CT scan finding.