Minimally Invasive Surgery Plus Recombinant Tissue-type Plasminagen Activator For SICH: Outcome And Later Seizures

Objective:to evaluate the effects of minimally invasive surgery Plus Recombinant Tissue-type plasminagen Activator compared with conservative treatment in treating spontanous supratentorial intracerebral hemorrhage and to identify the incidence and risk factors of later seizures after s ICHMethods:we retrospectively analysis the consecutive s ICH patients,whose volume ≥30m L,treated in our neurological center from June 2013 to October 2015.The patients were treated with minimally invasive surgery Plus Recombinant Tissue-type plasminagen Activator(MIS group) or conservative treatment(conservative group).The clinical characteristic of all the cases,for example gender,years,blood pressure and blood glucose and lipid on admission,initial GCS score,et.were recored.We called to identify their clinical outcome with modified Rankin Scale and evaluate the incidence of later seizures according to International League Against Epilepsy criteria.Results:One hundred and fifty nine patients were included in the st udy,while 105 cases received MIS treatment and 54 were treated conservatively.Compared with conservative group,The 30-day mortality of MIS group was significantly lower(18.1%vs.33.3%,P=0.031) and the clinical outcome was slightly better,which didn’t show significa ntly difference(P=0.09).However,incidence of later seizures in MIS g roup definitely overweighted that in conservative group(4.76%vs1.85%,12.1%vs2.13%,17.1%vs4.88%,at 3,6,12 month respectively). When analysised with Logistic regression analysis,age, bleeding to ventricle, and GCS on admission were the independent predictors of outcome,while the way to treat ICH was the only independent predictors of later epilepsy.Conclusion:MIS plus rt PA show no significant improvement of s ICH clinical outcome,but definitively reduce mortality.Age,bleeding to ventricle or subarachnoid space, GCS on admission and are independently predictors of clinical outcome.Seizures are a common complication after ICH,and surgerys suggest to promote the occurrence of epilepsy.