Primary intracerebral and aneurysmal subarachnoid hemorrhage in Izumo City, Japan. Part II: Management and surgical outcome

Object. The purpose of this study was to assess the overall management and surgical outcome of primary intracerebral hemorrhage (ICH) and aneurysmal s ubarachnoid hemorrhage (SAH) among the 85,000 residents of Izumo City, Japa n. Methods. During 1991 through 1996, 267 patients with ICH and 123 with SAH w ere treated in Izumo. Of the 267 patients with ICH, 25 underwent hematoma r emoval by open craniotomy or suboccipital craniectomy and 34 underwent ster eotactic evacuation of the hematoma, whereas aneurysm clipping was performe d in 71 of the 123 patients with SAH; operability rates were thus 22% for I CH and 58% for SAH (p < 0.0001). The overall 30-day survival rates were 86% for ICH and 66% for SAH (p < 0.0001) and the 2-year survival rates were 73 % and 62% (p = 0.0207), respectively. In patients who underwent surgery, 30 -day and 2-year survival rates were 93% for ICH and 100% for SAH (p = 0.026 2), and 75% for ICH and 97% for SAH (p = 0.0002), respectively. In patients with ICH, the most important predictors of 30-day case fatality rates were the volume of the hematoma, the Glasgow Coma Scale (GCS) score, rebleeding , and midline shifting, whereas those for 2-year survival were the GCS scor e, age, rebleeding, and hematoma volume. In patients with SAH, the most imp ortant determinants of 30-day case-fatality rates were the GCS score and ag e, whereas only the GCS score had a significant impact on 2-year survival. Conclusions. The overall survival rates for patients with ICH or SAH in Izu mo were more favorable than those in previously published epidemiological s tudies. However, despite improved surgical results, the overall management of ICH and SAH still produced an unsatisfactory outcome, mainly because of primary brain damage.