J Cerebrovasc Endovasc Neurosurg.  2018 Jun;20(2):96-105. 10.7461/jcen.2018.20.2.96.

Optimal Surgical Timing of Aspiration for Spontaneous Supratentorial Intracerebral Hemorrhage

Affiliations
  • 1Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul, Korea. c99867@schmc.ac.kr

Abstract


OBJECTIVE
Minimally invasive techniques such as stereotactic aspiration have been regarded as promising alternative methods to replace craniotomy in the treatment of intracerebral hemorrhage (ICH). The aim of this study was to identify the optimal timing of stereotactic aspiration and analyze the factors affecting the clinical outcome.
MATERIALS AND METHODS
This retrospective study included 81 patients who underwent stereotactic aspiration for spontaneous supratentorial ICH at single institution. Volume of hematoma was calculated based on computed tomography scan at admission, just before aspiration, immediately after aspiration, and after continuous drainage. The neurologic outcome was compared with Glasgow outcome scale (GOS) score.
RESULTS
The mean volume ratio of residual hematoma was 59.5% and 17.6% immediately after aspiration and after continuous drainage for an average of 2.3 days, respectively. Delayed aspiration group showed significantly lower residual volume ratio immediately after aspiration. However, there was no significant difference in the residual volume ratio after continuous drainage. The favorable outcome of 1-month GOS 4 or 5 was significantly better in the group with delayed aspiration after more than 7 days (p = 0.029), despite no significant difference in postoperative 6-months GOS score. A factor which has significant correlation with postoperative 6-months favorable outcome was the final hematoma volume ratio after drainage (p = 0.028).
CONCLUSION
There is no difference in final residual volume of hematoma or 6-months neurologic outcome according to the surgical timing of hematoma aspiration. The only factor affecting the postoperative 6-months

Keyword

Stereotaxic techniques; Cerebral hemorrhage; Minimally invasive surgical procedures

MeSH Terms

Cerebral Hemorrhage*
Craniotomy
Drainage
Glasgow Outcome Scale
Hematoma
Humans
Minimally Invasive Surgical Procedures
Residual Volume
Retrospective Studies
Stereotaxic Techniques

Figure

  • Fig. 1 The volume ratio before aspiration, after aspiration, and after drainage according to surgical timing. When compared the volume of hematoma according to surgical timing, there is no difference in volume before aspiration. However, the residual volume ration of the CT scan immediately after aspiration is significantly lower with delayed aspiration, without significant difference in the residual volume ratio of the last CT scan performed after drainage. CT = computed tomography.

  • Fig. 2 The ratio of favorable (GOS 4–5) and unfavorable outcome (GOS 1–3) after 1 and 6 months after aspiration according to surgical timing. The favorable outcome of 1–month GOS 4 or 5 is significantly better in the group with delayed aspiration after more than 7 days (p = 0.029). There is no significant difference in postoperative 6-months GOS score between the four patient groups (p = 0.363). GOS = Glasgow outcome scale.


Cited by  1 articles

Surgical strategy for patients with supratentorial spontaneous intracerebral hemorrhage: minimally invasive surgery and conventional surgery
Je Hun Jang, Won-Sang Cho, Noah Hong, Chang Hwan Pang, Sung Ho Lee, Hyun-Seung Kang, Jeong Eun Kim
J Cerebrovasc Endovasc Neurosurg. 2020;22(3):156-164.    doi: 10.7461/jcen.2020.22.3.156.


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