SURGERY FOR SPONTANEOUS INTRACEREBRAL HAEMORRHAGE IN BRUNEI DARUSSALAM: SURVIVAL AND LONG-TERM FUNCTIONAL OUTCOMES.
Albert Tiong Jeng LIM1, Roland Shen Hau POH1, John MATHEW1,2, Ady THIEN1,2.
1Department of Neurosurgery, Raja Isteri Pengiran Anak Saleha Hospital, Jalan Putera Al-Muhtadee Billah, BA1712 and 2Department of Neurosurgery, Brunei Neuroscience, Stroke and Rehabilitation Centre, Pantai Jerudong Specialist Centre, Jerudong, BG3122, Brunei Darussalam.
Introduction: Spontaneous intracerebral haemorrhage is an important cause of stroke with a significant 30-day mortality as high as 40%. Surgery for spontaneous intracerebral haemorrhage remains life-saving albeit with significant neurological sequelae. This study evaluated the survival and long-term functional outcomes of surgery for spontaneous intracerebral haemorrhage in Brunei Darussalam. Methods: A retrospective cohort study of patients who underwent surgery for spontaneous intracerebral haemorrhage between January 2015 and December 2018 was performed. 30-day and overall in-hospital mortality, and functional outcomes at 6 and 12 months were analysed. Logistic regression analysis was used to identify predictors of 30-day and overall in-hospital survivability. Results: Fifty-two patients (33 men and 19 women) with a median age of 50 years (interquartile range, 39-58) had undergone surgery for spontaneous intracerebral haemorrhage. The 30-day and overall in-hospital mortality were 26.9% and 38.5%, respectively. Haematoma evacuation ≥ 80% was significantly associated with 30-day survival, OR 9.46 (95% confidence interval, 1.12 – 79.84; p=0.039) and overall in-hospital survival, OR 7.94 (95% confidence interval, 1.58 – 40.03; p=0.012). 13.8% patients (4/29) achieved good favourable functional outcome (Modified Rankin Scale ≤ 3) at 6 and 12 months. Conclusion: Spontaneous intracerebral haemorrhages continue to be a devastating condition which is significantly associated with morbidity and mortality. The role of surgery for most patients remains a life-saving measure and the decision for surgery should be weighed against survivability with unfavourable functional outcomes.
KEYWORDS: Craniotomy, Cerebral haemorrhage, Functional Status, Intracranial haemorrhage, Hospital mortality.
CORRESPONDING AUTHOR: Dr Ady Thien, Associate Specialist, MBChB, FRCSEd (SN), Department of Neurosurgery, Brunei Neuroscience, Stroke and Rehabilitation Centre, Pantai Jerudong Specialist Centre, Jerudong, BG3122, Brunei Darussalam.Contact no: +6737173011 Email:
Brunei Int Med J. 2020;16:150-157