Temporal Lobectomy and Hematoma Removal for Large Hemorrhage of the Basal Ganglia

Yoon, Jong Seok; Hwang, Sung Nam; Park, Seung Won; Kwon, Jeong Taik; Kim, Young Baeg; Min, Byung Kook; Choi, Duk Young; Suk, Jong Sik

Abstract

Severe hemorrhage of the basal ganglia is usually associated with massive surrounding edema, and even after removal of the hematoma, edema persists for as long as several weeks and exerts an additional deleterious effect on the recovery from the ictus. To determine whether the provision of intracranial space will improve the outcome, we performed temporal lobectomy in addition to hematoma removal and compared the result with hematoma removal only. Over a three-year period from January 1993 to March 1996, we encountered 476 cases of spontaneous intracerebral hemorrhage and of these, 52 with severe hemorrhage of the basal ganglia were selected for this study. On admission, the neurological status of these 52 patients was very poor or progressively deteriorating, and all underwent surgical intervention. They were divided into two groups according to the surgical procedure : hematoma removal with temporal lobectomy(Group I) and hematoma removal only(Group II). GCS score at discharge, GOS score, Barthel index and mortality were compared between the two groups. In overall comparison of GCS score at discharge, GOS score, rate of persistent vegetative state, and death rate between the two groups, there was no significant difference, but among patients with a GCS score 6 and below, this score was higher and the rate of persistent vegetative state and death were lower in Group I than in Group II(p<0.05). Among those with a GCS score of above 6, there was no difference between the two groups. We conclude that for patients whose neurological status is poor(GCS score 6 and below), the benefit of temporal lobectomy in addition to hematoma removal is greater than that of hematoma removal alone.