Localization of hypertensive intracerebral hemorrhages in the Republic of Tatarstan

INTRODUCTION. The incidence of intracerebral hemorrhage is 9–35 per 100,000 population. Mortality in hypertensive intracerebral hemorrhage is the highest among all acute cerebrovascular disorders. While most intracerebral hemorrhages are treated conservatively, there are indications for surgical intervention. The choice between open and endoscopic surgical methods depends on the hematoma’s localization. Data on the distribution of hematomas of various localizations are essential to assess the appropriateness of using open or endoscopic interventions.

MATERIALS AND METHODS. A retrospective multicenter study was conducted, including data from patients with hypertensive intracerebral hemorrhages from 4 regional vascular centers and 14 primary vascular centers in the Republic of Tatarstan in 2022. Inclusion criteria: registered cases of hypertensive intracerebral hematoma from 01.01.2022 to 31.12.2022, age >18 years. Exclusion criteria: identification of non-traumatic intracerebral hematoma due to vascular anomalies (ruptured aneurysm, arteriovenous malformation, cavernous hemorrhage, etc.), hematoma within a tumor, coagulopathy, vasculopathy, hemorrhagic transformation.

RESULTS. The study included 1127 patients with hypertensive intracerebral hemorrhages. The median volume of intracerebral hematoma was 12 [4; 36] ml, with a maximum volume of 330 ml. Midline shift reached 27 mm. 56,1 % were male and 43,9 % were female. According to medical records among 1127 patients, putaminal hematomas were 33,1 %, thalamic 22,1 %, subcortical 22,8 %, mixed 6,3 %, cerebellar 6,8 %, brainstem 5,8 %, other 2,7 %, isolated intraventricular hemorrhage was 0,4 %. Neurovisualization data confirmed the localization in 786 patients, showing putaminal hematomas at 33,8%, thalamic 23,7 %, subcortical 18,8 %, mixed 7,6 %, cerebellar 7 %, brainstem 5,1 %, other 3,3 %, isolated intraventricular hemorrhage 0,6 % (*here in after sum of shares less than or more than 100 % due to rounding). Right-sided hematomas were 47 %, left-sided 46,2 %, bilateral 6,9 %. Blood breakthrough into the ventricular system occurred in 37,5 % of cases. In the surgical treatment group (87 patients), hematoma localization was putaminal 47,1 %, thalamic 6,9 %, subcortical 27,6 %, mixed 9,2 %, cerebellar 6,9 %, other 2,3 %. The highest hospital mortality (78 %) was in patients with mixed intracerebral hematoma localization. The lowest hospital mortality (17 %) was in patients with thalamic intracerebral hematomas. Different localization thresholds have been calculated, above which bad or lethal outcomes are predicted.

CONCLUSION. The structure of hypertensive intracerebral hematoma localization in the Republic of Tatarstan generally aligns with literature data, but thalamic hematomas occur slightly more frequently. More than half of the hematomas in the Republic of Tatarstan have deep localization, indicating that endoscopic methods of hematoma removal should dominate among surgical treatment options. The outcomes of the disease depend on the volume and localization of the intracerebral hematoma. Threshold values for the volume of intracerebral hematoma at various localizations have been calculated, exceeding which a poor or lethal outcome are predicted.

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