Search of factors affecting functional outcome and mortality in surgical treatment of Spontaneous Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) results in mortality and functional loss. Treatment guidelines aren't robust. Optimal surgical intervention and timing are controversial. We aimed to improve the outcome of surgical treatment by searching for associated factors. 125 patients who underwent surgery for ICH between 01.01.2018 – 01.01.2024 were retrospectively inspected. Demographics, comorbidities, antithrombotic drug use, hemostatic treatments, laboratory work (coagulation and complete blood count), Glasgow Coma Scale (GCS), Modified Rankin Scale (mRS) and Intracerebral Hemorrhage Score (ICH) scores, time interval to surgery, surgical approach, EVD insertion, complications, radiologic features (admission, preoperative and postoperative images were evaluated for hematoma location, hydrocephalus, hematoma volume, midline shift, hematoma expansion and predictors), mRS scores at discharge, 3 months, 6 months and 1 year follow up as well as mortality status at 1-3-6 months and 1 year. Findings of statistical analyses were as following: old age, lack of headache, low GCS score and high mRS-ICH scores at admission and preoperatively, early surgery, long length of stay, greater preoperative hematoma volume and shift, greater postoperative shift or residual volume were associated with poor functional outcome and mortality. Uremia, abnormal coagulation tests at admission, impairment of consciousness and lack of focal deficit at admission, EVD insertion, ICH as a complication, hydrocephalus, preoperative shift increase, rehemorrhage, existence of hypodensity and absence of fluid level on images were associated with mortality. Lack of nausea at admission, single hemostatic treatment for antithrombotic use, decompressive craniectomy approach, complications, wound infection, deep location of hematoma, black hole sign were associated with poor outcome. Preoperative shift and hematoma volume increase, severe neurological deterioration, complications, rehemorrhage and residual hematoma should be avoided to improve outcome.