Abstract
BackgroundSpontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke with the high mortality twofold to sixfold higher than that for ischemic stroke. But the treatment of haematomas within the basal ganglia continues to be a matter of debate among neurologists and neurosurgeons. The purpose of this study is to judge the clinical value of minimally invasive stereotactic puncture therapy (MISPT) on acute ICH.MethodsA prospective controlled study was undertaken. The clinical trial was in compliance with the WMA Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects. According to the enrollment criterion, there were 168 acute ICH cases analyzed, of which 90 cases were performed by MISPT ( MISPT group, MG) and 78 cases by Conventional craniotomy (CC group, CG), by means of compare of Glasgow Coma Scale(GCS) score, postoperative complications(PC) and rebleeding incidence(RI), moreover, long-term outcome of 1 year postoperation judged by Glasgow Outcome Scale (GOS), Barthel Index (BI), modified Rankin Scale (mRS) and case fatality(CF).ResultsMG patients showed obvious amelioration in GCS score compared with that of CG. The total incidence of PC in MG decreased obviously compared with that of CG. The incidences of rebleeding in MG and CG were 10.0% and 15.4% respectively. There was no obvious difference between CFs of MG and CG. For three parameters representing long-term outcome, the GOS, BI and mRS in MG were ameliorated significantly than that of CG.ConclusionThese data suggested that the advantage of MISPT was displayed in minute trauma and safety, and seemed to be feasible and to had a trend towards improved long-term outcome.Trial RegistrationThe Australian New Zealand Clinical Trials Registry (ANZCTR), the registration number:ACTRN12610000945022.
Highlights
Spontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke with the high mortality twofold to sixfold higher than that for ischemic stroke
All ICH patients came from in-hospital from 2005 to 2008, diagnosed as ICH according to the ICH criteria of which is drafted by ASA [12]
Volume of the ICH in milliliters was estimated on the basis of approximate ellipse volume with the A × B × C/2 formula, where A represents the largest diameter of the hematoma on axial CT cuts in centimeters, B the diameter of hematoma perpendicular to A on the same cut, and C the number of CT slices in which hematoma is visible multiplied by the slice thickness in centimeters [13,14]
Summary
Spontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke with the high mortality twofold to sixfold higher than that for ischemic stroke. The treatment of haematomas within the basal ganglia continues to be a matter of debate among neurologists and neurosurgeons. Acute intracerebral hemorrhage (AICH) is a devastating form of stroke with the higher mortality and lower survival rate [1,2]. With the highest mortality among all forms of cerebrovascular diseases, about half of the deaths following ICH occur in the first 2 days. Secondary brain injury by hematoma often occurs in the days following the initial hemorrhage and is intimately associated with significant neurological deterioration [5]. The treatment scheme of AICH especially within the basal ganglia remains a controversial issues among neurologists and neurosurgeons. More than 7000 patients with ICH in the United States ever undergo traditional evacuation procedures each year [7]
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