Download PDF
J Neurol Surg B Skull Base 2021; 82(02): 258-263
DOI: 10.1055/s-0039-1697037
Original Article

Clinical Study on Minimally Invasive Liquefaction and Drainage of Hypertensive Putaminal Hemorrhage through Frontal Approach

Gong W.
1   Department of Neurosurgery, The First People's Hospital of Kunshan, Jiangsu University, Suzhou, Jiangsu, People's Republic of China
,
Ma J.
2   Department of Neurosurgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
› Author Affiliations Sources of Funding and Support No funding was received for this work.
› Further Information
    Permissions and Reprints

Abstract

Background Hypertensive intracerebral hemorrhage is one of the most common cerebrovascular diseases with high mortality and high disability rate. The aim of this study was to observe the curative effect of minimally invasive liquefaction and drainage of hypertensive putaminal hemorrhage (HPH) through frontal approach.

Methods This study retrospectively reviewed the clinical data of 66 HPH patients who underwent surgery from January 2012 to January 2017 including 35 males and 31 females, aged 51 to 82 years, with an average age of 61.6 ± 7.32 years. All patients were treated in the first people’s hospital of Kunshan. They were divided into two groups: puncture thrombolysis and drainage therapy (PTDT) group and conventional craniotomy (CC) group.

Result The pulmonary infection rate in PTDT group was 13.8%, significantly lower than that of 27.7% in CC group (p < 0.05). One year after onset, the modified Rankin scale (mRS) score of surviving patients was evaluated. The mRS score of the PTDT group with 30 to 60 mL of preoperative bleeding was 1.91 ± 0.82, which was significantly better than that of the CC group (2.21 ± 0.83) (p < 0.05). There was no significant difference in mRS score between PTDT group (2.59 ± 0.62) and CC group (2.88 ± 0.87) with preoperative bleeding > 60 mL (p > 0.05). In patients with Glasgow coma scale (GCS) 5 to 8 scores, the mRS of PTDT and CC groups were 2.73 ± 0.72 and 2.94 ± 0.96, respectively (p > 0.05). In patients with GCS 9 to 13 scores, the mRS score of PTDT group was 1.83 ± 0.69, which was significantly better than that of CC group (2.06 ± 0.74) (p < 0.05).

Conclusion HPH can be treated effectively through PTDT. PTDT group has lower lung infection rate than CC group. And it can significantly improve the prognosis of patients with preoperative bleeding volume of 30 to 60 mL and preoperative GCS score of 9 to 13.

Keywords

hypertensive putaminal hemorrhage - frontal approach - puncture - rebleeding


Publication History

Received: 20 April 2019

Accepted: 11 August 2019

Article published online:
30 September 2019

© 2019. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Mendelow AD, Gregson BA, Fernandes HM. et al; STICH investigators. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet 2005; 365 (9457): 387-397
    CrossrefPubMedGoogle Scholar
  • 2 Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM. STICH II Investigators. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet 2013; 382 (9890): 397-408
    CrossrefPubMedGoogle Scholar
  • 3 Liu H, Zen Y, Li J. et al. Optimal treatment determination on the basis of haematoma volume and intra-cerebral haemorrhage score in patients with hypertensive putaminal haemorrhages: a retrospective analysis of 310 patients. BMC Neurol 2014; 14: 141
    CrossrefPubMedGoogle Scholar
  • 4 Kaya RA, Türkmenoğlu O, Ziyal IM, Dalkiliç T, Sahin Y, Aydin Y. The effects on prognosis of surgical treatment of hypertensive putaminal hematomas through transsylvian transinsular approach. Surg Neurol 2003; 59 (03) 176-183 , discussion 183
    CrossrefPubMedGoogle Scholar
  • 5 Zhang Y, Al-Aref R, Fu H. et al. Neuronavigation-assisted aspiration and electro-acupuncture for hypertensive putaminal hemorrhage: a suitable technique on hemiplegia rehabilitation. Turk Neurosurg 2017; 27 (04) 500-508
    PubMedGoogle Scholar
  • 6 Zhang HT, Chen LH, Xu RX. Distal transsylvian-traninsular approach for the putaminal hypertensive hemorrhages: surgical experience and technical note. J Craniofac Surg 2013; 24 (06) 2073-2076
    CrossrefPubMedGoogle Scholar
  • 7 Jianwei G, Weiqiao Z, Xiaohua Z, Qizhong L, Jiyao J, Yongming Q. Our experience of transsylvian-transinsular microsurgical approach to hypertensive putaminal hematomas. J Craniofac Surg 2009; 20 (04) 1097-1099
    CrossrefPubMedGoogle Scholar
  • 8 Zheng JS, Yang F, Xu QS, Yu JB, Tang LL. Treatment of hypertensive intracerebral hemorrhage through keyhole transsylvian approach. J Craniofac Surg 2010; 21 (04) 1210-1212
    CrossrefPubMedGoogle Scholar
  • 9 Hsieh PC, Cho DY, Lee WY, Chen JT. Endoscopic evacuation of putaminal hemorrhage: how to improve the efficiency of hematoma evacuation. Surg Neurol 2005; 64 (02) 147-153 , discussion 153
    CrossrefPubMedGoogle Scholar
  • 10 Nakano T, Ohkuma H, Ebina K, Suzuki S. Neuroendoscopic surgery for intracerebral haemorrhage--comparison with traditional therapies. Minim Invasive Neurosurg 2003; 46 (05) 278-283
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Sadahiro H, Nomura S, Goto H. et al. Real-time ultrasound-guided endoscopic surgery for putaminal hemorrhage. J Neurosurg 2015; 123 (05) 1151-1155
    Google Scholar
  • 12 Lin HL, Lo YC, Liu YF, Cho DY. Endoscopic evacuation of hypertensive putaminal hemorrhage guided by the 3D reconstructed CT scan: a preliminary report. Clin Neurol Neurosurg 2010; 112 (10) 892-896
    CrossrefPubMedGoogle Scholar
  • 13 Ding D, Przybylowski CJ, Starke RM. et al. A minimally invasive anterior skull base approach for evacuation of a basal ganglia hemorrhage. J Clin Neurosci 2015; 22 (11) 1816-1819
    CrossrefPubMedGoogle Scholar