Abstract
Introduction: The role of surgery in spontaneous intracerebral haemorrhage (sICH) remains controversial. This leads to variation in the percentage of patients who are treated with surgery between countries.
Patients and methods: We sent an online survey to all neurosurgeons (n = 140) and to a sample of neurologists (n = 378) in Dutch hospitals, with questions on management in supratentorial sICH in general, and on treatment in six patients, to explore current variation in medical and neurosurgical management. We assessed patient and haemorrhage characteristics influencing treatment decisions.
Results: Twenty-nine (21%) neurosurgeons and 92 (24%) neurologists responded. Prior to surgery, neurosurgeons would more frequently administer platelet-transfusion in patients on clopidogrel (64% versus 13%; p = 0.000) or acetylsalicylic acid (61% versus 11%; p = 0.000) than neurologists. In the cases, neurosurgeons and neurologists were similar in their choice for surgery as initial treatment (24% and 31%; p = 0.12), however variation existed amongst physicians in specific cases. Neurosurgeons preferred craniotomy with haematoma evacuation (74%) above minimally-invasive techniques (5%). Age, Glasgow Coma Scale score and ICH location were important factors influencing decisions on treatment for neurosurgeons and neurologists. 69% of neurosurgeons and 80% of neurologists would randomise patients in a trial evaluating the effect of minimally-invasive surgery on functional outcome.
Discussion: Our results reflect the lack of evidence about the right treatment strategy in patients with sICH.
Conclusion: New high quality evidence is needed to guide treatment decisions for patients with ICH. The willingness to randomise patients into a clinical trial on minimally-invasive surgery, contributes to the feasibility of such studies in the future.
| Original language | English |
|---|---|
| Pages (from-to) | 134-142 |
| Number of pages | 9 |
| Journal | European Stroke Journal |
| Volume | 6 |
| Issue number | 2 |
| Early online date | 7 Apr 2021 |
| DOIs | |
| Publication status | Published - Jun 2021 |
Bibliographical note
Funding Information:None. We acknowledge the support of the Netherlands Cardiovascular Research Initiative, which is supported by the Dutch Heart Foundation, CVON2015?01: CONTRAST, and the support of the Brain Foundation Netherlands (HA2015?01?06) and the support of Health?Holland, Top Sector Life Sciences & Health (LSHM17016), Medtronic and Cerenovus. CJM Klijn and FHBM Schreuder are supported by a clinical established investigator grant of the Dutch Heart Foundation (grant 2012T077) and CJM Klijn by an ASPASIA grant from The Netherlands Organization for Health Research and Development, ZonMw (grant 015008048). FHBM Schreuder is supported by a senior clinical scientist grant of the Dutch Heart Foundation (grant 2019T060).
Funding Information:
We acknowledge the support of the Netherlands Cardiovascular Research Initiative, which is supported by the Dutch Heart Foundation, CVON2015–01: CONTRAST, and the support of the Brain Foundation Netherlands (HA2015·01·06) and the support of Health∼Holland, Top Sector Life Sciences & Health (LSHM17016), Medtronic and Cerenovus. CJM Klijn and FHBM Schreuder are supported by a clinical established investigator grant of the Dutch Heart Foundation (grant 2012T077) and CJM Klijn by an ASPASIA grant from The Netherlands Organization for Health Research and Development, ZonMw (grant 015008048). FHBM Schreuder is supported by a senior clinical scientist grant of the Dutch Heart Foundation (grant 2019T060).
Publisher Copyright:
© European Stroke Organisation 2021.