Spontaneous Intracerebral Hematoma Operated in Two Neurosurgical Centers in Madagascar

Primary spontaneous intra-parenchymal haematomas are associated with high morbidity and mortality and are rarely operated on.The aim of this study is to report the characteristics of primary intra-parenchymal haematomas operated in two neurosurgical centres in Madagascar.This is a retrospective descriptive and analytical transversal study over a period of 5 years.We collected 32 patient files.The average age was 51.6 years.The sex ratio was 1.66.All patients were hypertensive.The Glasgow score was between 8 and 14 in 56.3%.Motor deficit was identified in 84.4%.Brain MRI was performed in 6.2% and no arteriography was performed.The haematoma was sustentorial in 84.4% and subtentorial in 15.6%.Hydrocephalus was found in 31.2%.The volume of the haematoma was greater than 30 ml in 75%.For cerebellar haematomas, craniectomy with evacuation of the haematoma after a CSF shunt is used.Craniotomy with evacuation of the hematoma for sustentorial hematoma.The mortality rate was 40.6%.The mRS score was 0-2 at 3 months in 29.4%.Preoperative GCS greater than 8 was associated with low mortality (p = 0.001).There is still no consensus on the surgical indication.The decision for surgery must be considered on a case-by-case basis.