308 Comparison of Demographics and Outcomes Between Surgical and Conservative Management in Patients Undergoing Treatment for Posterior Cranial Fossa Hemorrhages—Experience from a Low-Resource Country. (1st April 2022)

• Record Type: Journal Article
• Authors: Aziz, Hafiza F.; Hani, Ummey; Suleman, Fatima; Qadeer, Namra; Nazir, Danyal; Shamim, Shahzad M.; Zahid, Nida
• Is Part Of: Neurosurgery. Volume 68(2022)Supplement 1
• Page Start: 68
• Page End: 68
• Publication Date: 2022-04-01
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/NEU.0000000000001880_308
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : INTRODUCTION: Posterior Cranial Fossa Hemorrhages (PCFH) often require surgical intervention. However, comparison between outcomes in surgical vs conservative management has ben rarely sought in the literature. METHODS: Retrospective review of patient data was conducted under IRB approval. All patients managed for PCFH at Aga Khan University, Karachi, Pakistan, from January 2009 to December 2020 were included. SPSS (IBM) was utilized to analyze data. RESULTS: Surgery vs Conservative: Out of 79 patients, 30.7% vs 69.6% patients underwent each, respectively. Mean age 51 +/- 16.4 vs 56+/-10.7. Males (62.5% vs 70.9%), and females (37.5% v 29.1%). Median GCS at presentation was 9 vs 13. Surgery was indicated at initial presentation (54.2%) or if clinical deterioration was observed (29.2%). Radiographically, significant differences were noted in the mean Intracranial Hemorrhage Score (ICH) (3 vs 2; p = 0.036), maximum hematoma diameter (3.37 vs 2.31 cm; p < 0.001), brainstem involvement (2 vs 32; p < 0.001), 4th ventricle abnormality (100% vs 23%; p < 0.001); intraventricular hemorrhage (78.3% vs 29.4%; p < 0.001), tight posterior fossa (87% vs 37.3%; p < 0.001); clot location (hemispheric vs brainstem; 41.7% vs 52.9%; p = 0.001); median temporal horn width (2.1 vs 0.38 cm; p < 0.001) and clot volume (14.7 cm 3 vs 5.5 cm 3 ; p < 0.001). Differences in median length of hospital, ventilator, and ICU stays (14.5 vs 4; p < 0.001, 1.5 vs 0; p < 0.001 and 3 vs 0 days; p < 0.001 respectively), tracheostomy (5% vs 1%; p = 0.003), Infection rate (66.6 vs 29.1%; p < 0.001) and median overall survival (53 vs 10 months; p = 0.046) were all significant. CONCLUSION: While surgery increased survival, significant morbidity and late hospital discharge was observed in patients undergoing surgery for PCFH.