Turkish Neurosurgery
2018 , Vol 28 , Num 4
Prognostic Role of Perihematomal Edema in Intracerebral Hemorrhage: A Systematic Review
1West China Hospital, Sichuan University, Department of Neurosurgery, Chengdu, China
DOI :
10.5137/1019-5149.JTN.19659-16.0
Although several studies have suggested perihematomal edema (PHE) is associated with prognosis in intracerebral hemorrhage
(ICH), the results are different in other studies. The purpose of this study was to evaluate the prognostic role of PHE in ICH.
According to PRISMA guidelines, a systematic literature search of PubMed, EMBASE, SCOPUS, Web of Science and Cochrane
Library was performed. Published clinical studies reporting association between PHE and prognosis in ICH were included. Data
were extracted including sample size, patient characteristics, PHE measures, outcome measures and follow-up. A total of 21
studies were included with 6 prospective studies and 15 retrospective studies. PHE measures included perihematomal edema
absolute volume (PHEAV), relative perihematomal edema volume (rPHE), perihematomal edema absolute volume growth (PHEAV
growth), perihematomal edema expansion rate (PHEER), relative perihematomal edema growth (relative PHE growth), cytotoxic
edema (CE) and perihematomal edema absolute area (PHEAA). The association of PHEAV/ rPHE /PHEAV growth and outcome are
conflicting in different studies. Meta-analysis showed PHEER at 72 hours was significantly associated with poor clinical outcome at
90 days (OR=1.54, 95%CI 1.04-2.22, p<0.001). This study suggests the measures and time points for PHE and outcome are various
in previous studies. The prognostic values of PHEAV, rPHE, PHEAV growth and other measures are still controversial. PHEER is
likely a prognostic predictor for ICH. Further studies with larger sample size, more accurate measures and more time points are
needed to investigate the prognostic role of PHE in ICH and the optimal PHE measure to predict outcome in ICH.
Keywords :
Perihematomal edema, Intracerebral hemorrhage, Prognosis