1 / 9

What is it?

Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. A David Mendelow et al, Lancet 2005; 365: 387–97. What is it?.

ianna
Download Presentation

What is it?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Early surgery versus initial conservative treatment in patients with spontaneous supratentorialintracerebral haematomas in the International Surgical Trial in IntracerebralHaemorrhage (STICH): a randomised trial. A David Mendelow et al, Lancet 2005; 365: 387–97

  2. What is it? • large multicentre study • Oldish • Prospective, centrally randomised (clinical equipoise)

  3. Outcomes Prognostic score=(10admission Glasgow coma score)–age (years)–(0·64volume[mL]). Patients divided into good and poor prognosis groups Poor Prognosis - favourable outcome included the good recovery, moderate disability, and upper severe disability categories of the extended Glasgow outcome scale, Good prognosis - favourable outcome encompassed good recovery and moderate disability.

  4. Results Minimal total cost difference 122 (26%) patients allocated to early surgery had a favourable outcome at 6 months, compared with 118 (24%) allocated to initial conservative treatment (odds ratio 0·89 [95% CI 0·66–1·19], p=0·414. Early surgery had an absolute benefit of 2·3%

  5. Acute Surgical Treatment For Haemorrhage Intracerebraland cerebellarhaemorrhages have higher morbidity and mortality rates than ischemic stroke: Awake patients with small haematomas (<3 cm diameter) usually recover without surgery. Comatose patients with large haemorrhages (>6 cm diameter) usually do poorly, regardless of management.

  6. Posterior fossa haemorrhage Cerebellarhemorrhage and infarction can rapidly compress the brainstem and halt respiratory function therefore Immediate neurosurgical consultation/ transfer is recommended for moderate-to-large hematomas in the posterior fossa. The size of the hemorrhage or infarction is critical: • Cerebellarhemorrhage or infarction (< 3 cm) can often be managed with observation • Surgical intervention for patients with large cerebellarhemorrhages, (even if the patient is comatose) is common practice although there are no data proving outcome benefit

  7. Early mortality in spontaneous supratentorialintracerebral haemorrhage.Samprón N, Mendia A, Azkarate B, Alberdi F, Arrazola M, Urculo E. Neurocirugia (Astur). 2010 Apr;21(2):93-8. – prospective observational study 1485 patients – Primary outcome – early mortality (any cause) - benefit if GCS 4-8.

  8. The effect of the results of the STICH trial on the management of spontaneous supratentorialintracerebral haemorrhage in Newcastle.Kirkman MA et alBr J Neurosurg. 2008 Dec;22(6):739-46 478 Documented reduction in neurosurgery admissions/ procedures and increased stroke unit admissions with trend to increased survival rates overall. (@30 days)

  9. Neurosurgical outcomes after intracerebralhemorrhage: results of the Factor Seven for Acute Hemorrhagic Stroke Trial (FAST). Steiner T et al J Stroke Cerebrovasc Dis. 2011 JulAug;20(4):287-94 Sub group analysis – Worse outcome (mortality) in those whoe received surger. Younger patients with superficial haematomas and deteriorating GCS – trend to benefit.

More Related