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Postoperative Outcome of Cerebral Amyloid Angiopathy-Related Lobar Intracerebral Hemorrhage: Case Series and Systematic Review

Zhang, Yi MD*; Wang, Xin PhD; Schultz, Caleb MD§; Lanzino, Giuseppe MD; Rabinstein, Alejandro A. MD*

doi: 10.1227/NEU.0b013e31822ea02a
Research-Human-Clinical Studies

BACKGROUND: Despite its accessible superficial location, the indication for surgical evacuation in cases of lobar intracerebral hemorrhage (LICH) suspected to be related to cerebral amyloid angiopathy (CAA) is controversial because of advanced patient age and concerns about postoperative hemostasis.

OBJECTIVE: To examine factors associated with postoperative outcome in CAA-related LICH.

METHODS: Review of consecutive patients with pathologically proven CAA who underwent LICH evacuation at Saint Marys Hospital, Rochester, Minnesota, between 1987 and 2006. End points were length of stay and postoperative outcome at discharge and last follow-up using the Glasgow Outcome Scale. We also performed a systematic review of all published studies evaluating the outcome of surgically treated CCA-related LICH published between 1984 and 2010.

RESULTS: We identified 23 patients with CAA-related LICH treated surgically. Favorable outcome (Glasgow Outcome Scale >3) at discharge was noted in 5 patients (22%), and at 6- to 12-month follow-up (n = 15) in 7 patients (47%). Three (13%) died in the hospital, including 1 of 4 patients with postoperative hemorrhage. Intraventricular hemorrhage (IVH) was associated with poor outcome at discharge. Older age (≥75 years), history of hypertension, and degree of preoperative midline shift were associated with more prolonged length of stay. In our systematic review, we identified 14 studies including 278 cases. Overall mortality rate was 25%, and poor postoperative outcome was associated with older age, IVH, and preoperative dementia.

CONCLUSION: Neurosurgical evacuation may be performed with acceptable safety in patients with CAA-related LICH. A systematic literature review indicates that older age, preexistent dementia, and presurgical IVH portend poor postoperative outcome.

*Department of Neurology, Mayo Clinic, Rochester, Minnesota

Division of Biomedical Statistics and Informatics, Health Science Research, Mayo Clinic, Rochester, Minnesota

§Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota

Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota

Correspondence: Alejandro A. Rabinstein, MD, Department of Neurology, Mayo Clinic, 200 First Street SW, Mayo W8B, Rochester, MN 55905. E-mail:

Received November 1, 2010

Accepted May 11, 2011

Copyright © by the Congress of Neurological Surgeons