Temporal muscle thickness and index predict overall survival after surgical evacuation of spontaneous intracerebral hemorrhage

The prognosis of spontaneous intracerebral hemorrhage (ICH) is poor, but an accurately selected subset of patients benefits from surgery. Loss of muscle mass is associated with various geriatric syndromes and poor overall physiological capacity. We investigated whether temporal muscle thickness (TMT) and temporal muscle index (TMI), non-invasive indicators of whole-body muscle mass, predict overall survival (OS) in surgically treated spontaneous ICH. We identified all patients with surgically evacuated spontenous supratentorial ICHs in a single centre between 2014 and 2022. We measured TMT and TMI from preoperative computed tomography scans, and tested the prognostic capability of these measurements for post-operative OS. Cut-off values were calculated to divide patients into low and normal muscle status groups according to TMT and TMI. The median age of the 63 patients included in the study was 67 years (IQR 57-72), and 37 (59 %) were males. The overall mortality during the median follow-up period of 36 months (IQR 1-79) was significantly higher in the low muscle status group, as assessed using TMT and TMI cut-offs (67 % vs. 30 %, HR 2.65, 95 % CI 1.23-5.65, and 67 % vs. 31 %, HR 2.37, 95 % CI 1.11-5.04, respectively). The association persisted when adjusted with ICH score, pupillary status and blood pressure on admission (TMT HR 2.75, 95 % CI 1.27-5.96, TMI HR 2.30, 95 % CI 1.07-4.97). TMT and TMI provide prognostic information supplemental to established outcome predictors in surgically treated ICH. These parameters may improve surgical patient selection and detection of patients at risk of poor outcomes who might benefit from intensified post-operative ancillary care.