Gene, Teo Eu
(2020)
Sonography assisted clot evacuation in
early intracerebral haemorrhage.
Masters thesis, Universiti Sains Malaysia.
Abstract
Spontaneous intracerebral haemorrhages (ICH) are an increasingly common condition
that leads to severe morbidities and mortality. Early surgical evacuation of spontaneous
supratentorial ICHs has not consistently been proven to be beneficial from multiple
studies. We investigate the effectiveness of ultrasound guided early surgical evacuation
of spontaneous supratentorial ICHs with respect to the completeness of evacuation on
radiological evaluation. We prospectively recruited 58 patients who presented to a tertiary Neurosurgery centre
in Malaysia within 48 hours of ictus for a spontaneous supratentorial ICH and underwent
surgical evacuation of clot between June 2017 to February 2019. The patients were
randomly assigned to surgical evacuation of clot with or without intraoperative ultrasound
guidance in 1:1 ratio. Pre operative and immediate post operative CT brain images were
compared. The primary outcome was the completeness of clot evacuation measured via
the (a x b x c)/2 formula. The patient or their family underwent a telephone interview 3
months post surgery to assess neurological outcome. 29 patients were randomly assigned to both early surgical evacuation of clot with and
without intraoperative ultrasound guidance. All patients were followed up at 3 months.
Patients in the surgical evacuation with intraoperative ultrasound guidance and without
intraoperative ultrasound guidance had mean reductions of 88.7% and 86.9%
respectively, which was statistically significant, p value = 0.022. Mortality rate at 3 months for both groups was 10.3% and 20.1% respectively. (OR 2.3, 95% CI 0.51 to
10.08; p = 0.285).
Conclusion Ultrasound guided evacuation of spontaneous supratentorial ICHs increases the
completeness of clot evacuation via radiological evaluation.
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