J Korean Neurosurg Soc.  2008 Jul;44(1):1-7. 10.3340/jkns.2008.44.1.1.

Open Surgical Evacuation of Spontaneous Putaminal Hematomas: Prognostic Factors and Comparison of Outcomes between Transsylvian and Transcortical Approaches

Affiliations
  • 1Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea. smyoon@sch.ac.kr

Abstract


OBJECTIVE
The purpose of this study was to investigate the factors affecting the surgical outcome and to compare the surgical results between transsylvian and transcortical approaches in patients with putaminal hematomas. METHODS: Retrospective review of charts and CT scan images was conducted in 45 patients (20 transsylvian and 25 transcortical approaches) who underwent open surgical evacuation of putaminal hematomas. Mean Glasgow coma scale (GCS) score and hematoma volume were 7.5+/-3.2 and 78.1+/-29.3 cc, respectively. The factors affecting the functional mortality were investigated using a multivariate logistic regression analysis. In addition, surgical results between transsylvian and transcortical approaches were compared. RESULTS: None of the patients had a good recovery after the surgery. Overall functional survival rate and mortality were 37.7% and 31%, respectively. The only risk factor for functional mortality was GCS motor score after controlling age, history of hypertension, side of hematoma, hematoma amount, midline shift, presence of intraventricular hemorrhage and surgical approach (p=0.005). Even though a transcortical approach was shorter in operative time (4.4 versus 5.1 hour) and showed a higher mortality rate (40% versus 20%) and lower functional survival (45% versus 35%) compared to the transsylvian approach, the differences were not statistically significant between the two groups. CONCLUSION: In patients who have large amounts of hematoma and require open surgical evacuation, the only significant risk factor for functional survival is the preoperative GCS score. Cortical incision methods such as transsylvian and transcortical approaches have no influence on the surgical outcome. To decompress the swollen brain rapidly, transcortical approach seems to be more suitable than transsylvian approach.

Keyword

Putaminal hemorrhage; Craniotomy; Glasgow coma scale; Mortality

MeSH Terms

Brain
Craniotomy
Glasgow Coma Scale
Hematoma
Hemorrhage
Humans
Hypertension
Logistic Models
Operative Time
Putaminal Hemorrhage
Retrospective Studies
Risk Factors
Survival Rate
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