METHODS: A double-blinded, randomised, placebo-controlled study was carried out among adults with non-traumatic ICH. Eligible study subjects were randomly assigned to receive placebo, 2-g TXA treatment or 3-g TXA treatment. Haematoma volumes before and after intervention were measured using the planimetric method.
RESULTS: A total of 60 subjects with 20 subjects in each treatment group were recruited for this study. Among the 60 subjects, the majority were male (n = 36, 60%), had known cases of hypertension (n = 43, 71.7%) and presented with full Glasgow coma scale (GCS) (n = 41, 68.3%). The results showed that there was no statistically significant difference (P = 0.315) in the mean changes of haematoma volume when compared with three study groups using ANCOVA, although the 3-g TXA group was the only group that showed haematoma volume reduction (mean reduction of 0.2 cm3) instead of expansion as in placebo (mean expansion 1.8 cm3) and 2-g TXA (mean expansion 0.3 cm3) groups. Good recovery was observed in all study groups, with only three subjects being moderately disabled. No adverse effects were reported in any of the study groups.
CONCLUSION: To the best of our knowledge, this is the first clinical study using 3 g of TXA in the management of non-traumatic ICH. From our study, 3 g of TXA may potentially be helpful in reducing haematoma volume. Nonetheless, a larger-scale randomised controlled trial should be carried out to further establish the role of 3 g of TXA in non-traumatic ICH.
METHODS: This descriptive historical vignette and service evaluation reviewed aggregated neurosurgical data from Tawau Hospital, Duchess of Kent Hospital (Sandakan), and Lahad Datu Hospital from 2019 through April 2026. Service activity was analysed across three phases: the flying surgeon model, rotational specialist postings, and permanent specialist deployment. Referrals, admissions, outpatient attendance, operative activity, interhospital transfers, and mortality were evaluated descriptively.
RESULTS: The East Coast Sabah Neurosurgical Service evolved from a monthly visiting service to rotational specialist coverage and, ultimately, a permanent Tawau-based hub in 2025. Referrals, outpatient attendance, and operative workload increased progressively across the three phases. Mean annual referrals increased from 1,388 to 1,802 and reached an annualised 2,130 during early Phase 3. Annual outpatient attendance increased from 1,117 to 1,675, with an annualised total of 2,526 visits. Operative volume increased from 202 to 366, with an annualised total of 374 procedures, while the proportion of elective procedures rose from 1.9% to 16.5%. Crude inpatient mortality rates were 5.8%, 4.9%, and 3.2% across the three phases. Following establishment of the permanent hub, emergency transfers from Tawau decreased from approximately 35 per year during Phase 2 to an annualised 18 per year during early Phase 3, corresponding to a crude administrative estimate of annual government cost avoidance of approximately RM425,000 to RM680,000 through reduced emergency air evacuations.
CONCLUSION: The phased decentralisation of neurosurgical services in Tawau was associated with expanded local capacity, improved continuity of care, and reduced reliance on transfers to a tertiary referral centre for selected neurosurgical conditions.