Early mortality in spontaneous supratentorial intracerebral haemorrhage Mortalidad temprana en hemorragia intracerebral supratentorial espontánea

Background: Spontaneous supratentorial intracerebral haemorrhage is a severe, frequent, and poorly understood condition. Despite the publication of 12 randomised controlled trials on this subject, the role of surgery remains controversial and no treatment has proved to be effective. We report on a ten year prospective cohort study based on a defined population treated with or without surgery and their outcome in terms of early survival. Methods: Population based, ten year prospective observational study directed to patients consecutively admitted to the Intensive Care Unit (ICU) in a tertiary centre with spontaneous supratentorial intracerebral haemorrhage. Patients were distributed in five groups according to the Glasgow Coma Score (GCS) at admission. Haemorrhages were classified as deep-seated or superficial. All patient received standard medical care, and additionally surgery if it was found indicated by the duty neurosurgeon. Primary endpoint was early mortality defined as dead occurred by any cause during the admission in the ICU. Findings: During the ten year period, 1.485 patients were admitted to our centre with primary intracerebral haemorrhage. Of these, 376 were admitted to the intensive care unit and 285 sustained supratentorial haemorrhages. Low GCS was strong predictor of early mortality. Despite the larger size of haematomas in patients undergoing surgical evacuation, surgery was associated with lower early mortality in all GCS subgroups. Maximal benefit was observed in patient with admission GCS of 4-8. Superficial haematomas were operated on more often, and were associated with lower mortality rate than deep-seated cases. Conclusions: Our findings suggest that craniotomy for haematoma evacuation may reduce early mortality in patients with primary supratentorial intracerebral haemorrhage. Surgery seems specially useful in patients with admission GCS between 4 and 8, and in those with superficial haemorrhages. Introducción: La hemorragia intracerebral supratentorial espontánea es un proceso frecuente, grave y poco comprendido. A pesar de la publicación de 12 ensayos clínicos controlados sobre el tema, la indicación quirúrgica es controvertida y ningún tratamiento se ha mostrado efectivo. Presentamos los resultados de un estudio prospectivo de cohortes desarrollado a lo largo de diez a os en una población definida. Los pacientes recibieron tratamiento quirúrgico o conservador y su evolución se describe en términos de mortalidad temprana. Material y métodos: Estudio prospectivo y observacional basado en una población definida en el que se in