J Korean Neurosurg Soc.  2015 Oct;58(4):373-378. 10.3340/jkns.2015.58.4.373.

Stereotactic Hematoma Removal of Spontaneous Intracerebral Hemorrhage through Parietal Approach

• Kim JH
• Cho TG
• Moon JG
• Kim CH
• Lee HK

• KMID: 2114376
• DOI: http://doi.org/10.3340/jkns.2015.58.4.373

Abstract

OBJECTIVE
To determine the advantages of parietal approach compared to Kocher's point approach for spontaneous, oval-shaped intracerebral hemorrhage (ICH) with expansion to the parietal region.
METHODS
We divided patients into two groups : group A had burr holes in the parietal bone and group B had burr holes at Kocher's point. The hematoma volume, Glasgow coma scale (GCS) score, and modified Barthel Index (mBI) score were calculated. At discharge, we evaluated the patients' Glasgow outcome scale (GOS) score, modified Rankin Scale (mRS) score, motor grade, and hospitalization duration. We evaluated the patients' mBI scores and motor grades at 6 months after surgery.
RESULTS
The hematoma volume in group A was significantly less than that in group B on postoperative days 1, 3, 5, 7, 14, and 21. Group A had significantly higher GCS scores than did group B on postoperative days 1 and 3. Group A had higher mBI scores postoperatively than did group B, but the scores were not significantly different. No differences were observed for the GOS score, mRS score, motor grade at discharge, or duration of hospitalization. The mBI score of group A at 6 months after surgery was significantly higher, and more patients in group A showed muscle strength improvement.
CONCLUSION
In oval-shaped ICH with expansion to the parietal region, the parietal approach is considered to improve the clinical symptoms at the acute phase by removing the hematoma more effectively in the early stages. The parietal approach might help promote the long-term recovery of motor power.

Keyword

Intracerebral hemorrhage; Parietal bone; Stereotactic; Glasgow coma scale

MeSH Terms

Cerebral Hemorrhage*
Glasgow Coma Scale
Glasgow Outcome Scale
Hematoma*
Hospitalization
Humans
Muscle Strength
Parietal Bone
Rabeprazole*

Figure

• 

  Fig. 1 Brain computed tomography (CT) scans of a 50-year-old man showing a hematoma in the left basal ganglia. A : Axial CT image showing a round hematoma. B : Coronal CT image showing an oval-shaped, spontaneous ICH and an intraventricular hematoma. C : Sagittal CT image showing an oval-shaped, spontaneous ICH that extends to the parietal lobe.

• 

  Fig. 2 The burr hole was placed posterior to the parietal eminence so that it would not induce motor cortex injury, and the route and direction of catheter insertion were decided.

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  Fig. 3 Pre- and post-operative computed tomography (CT) scans of a 57-year-old female patient with a hematoma that had expanded to the basal ganglia and parietal region. A : Preoperative CT scans in the sagittal plane. B : At postoperative day 1, the CT scans show a decrease in hematoma size and three catheters in the hematoma. C : At postoperative day 3, CT scans show an even smaller hematoma and the two remaining catheters.

Reference

1. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. A prospective study of acute cerebrovascular disease in the community : the Oxfordshire Community Stroke Project--1981-86. 2. Incidence, case fatality rates and overall outcome at one year of cerebral infarction, primary intracerebral and subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 1990; 53:16–22. PMID: 2303826.

2. Broderick JP, Brott T, Tomsick T, Miller R, Huster G. Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage. J Neurosurg. 1993; 78:188–191. PMID: 8421201.

3. Castellanos M, Leira R, Tejada J, Gil-Peralta A, Dávalos A, Castillo J. Stroke Project, Cerebrovascular Diseases Group of the Spanish Neurological Society. Predictors of good outcome in medium to large spontaneous supratentorial intracerebral haemorrhages. J Neurol Neurosurg Psychiatry. 2005; 76:691–695. PMID: 15834028.

4. Cho SH, Kim SH, Choi BY, Cho SH, Kang JH, Lee CH, et al. Motor outcome according to diffusion tensor tractography findings in the early stage of intracerebral hemorrhage. Neurosci Lett. 2007; 421:142–146. PMID: 17566651.

5. Cho TG, Nam DH, Cho BM, Lee JI, Kim JS, Hong SC, et al. Stereotactic evacuation of spontaneous intracerebral hemorrhage. J Korean Neurosurg Soc. 1999; 28:237–245.

6. Delgado P, Alvarez-Sabín J, Abilleira S, Santamarina E, Purroy F, Arenillas JF, et al. Plasma d-dimer predicts poor outcome after acute intracerebral hemorrhage. Neurology. 2006; 67:94–98. PMID: 16832084.

7. Duffau H. Intraoperative direct subcortical stimulation for identification of the internal capsule, combined with an image-guided stereotactic system during surgery for basal ganglia lesions. Surg Neurol. 2000; 53:250–254. PMID: 10773257.

8. Fewel ME, Thompson BG Jr, Hoff JT. Spontaneous intracerebral hemorrhage : a review. Neurosurg Focus. 2003; 15:E1. PMID: 15344894.

9. Jang SH. A review of corticospinal tract location at corona radiata and posterior limb of the internal capsule in human brain. NeuroRehabilitation. 2009; 24:279–283. PMID: 19458436.

10. Jang SH. The recovery of walking in stroke patients : a review. Int J Rehabil Res. 2010; 33:285–289. PMID: 20805757.

11. Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke. 1996; 27:1304–1305. PMID: 8711791.

12. Kuo LT, Chen CM, Li CH, Tsai JC, Chiu HC, Liu LC, et al. Early endoscope-assisted hematoma evacuation in patients with supratentorial intracerebral hemorrhage : case selection, surgical technique, and long-term results. Neurosurg Focus. 2011; 30:E9. PMID: 21456936.

13. Kwon H, Jang SH. Delayed recovery of gait function in a patient with intracerebral haemorrhage. J Rehabil Med. 2012; 44:378–380. PMID: 22434422.

14. Pantazis G, Tsitsopoulos P, Mihas C, Katsiva V, Stavrianos V, Zymaris S. Early surgical treatment vs conservative management for spontaneous supratentorial intracerebral hematomas : a prospective randomized study. Surg Neurol. 2006; 66:492–501. discussion 501-502PMID: 17084196.

15. Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF. Spontaneous intracerebral hemorrhage. N Engl J Med. 2001; 344:1450–1460. PMID: 11346811.

16. Qureshi AI, Wilson DA, Hanley DF, Traystman RJ. Pharmacologic reduction of mean arterial pressure does not adversely affect regional cerebral blood flow and intracranial pressure in experimental intracerebral hemorrhage. Crit Care Med. 1999; 27:965–971. PMID: 10362421.

17. Tanizaki Y. Improvement of cerebral blood flow following stereotactic surgery in patients with putaminal haemorrhage. Acta Neurochir (Wien). 1988; 90:103–110. PMID: 3281415.