Can minimally invasive puncture and drainage for hypertensive spontaneous Basal Ganglia intracerebral hemorrhage improve patient outcome: a prospective non-randomized comparative study.

Guo-Qiang Wang,Wei-Wei Zhang,Yun-Jun Li,Yun-Yan Ding,Wei-Min Yin,Pei-Jian Li,Zheng-Jun Ren,Jia-Zhen Qin,Wen-Wei Ruan,Ji-Qiang Zhu,Yong-Hua Huang,Ying Li,Jun-Qi Peng,Shi-Qiang Li

doi:10.1186/2054-9369-1-10

Abstract

BackgroundThe treatment of hypertensive spontaneous intracranial hemorrhage (ICH) is still controversial. The purpose of the present study was to investigate whether minimally invasive puncture and drainage (MIPD) could improve patient outcome compared with decompressive craniectomy (DC).MethodsConsecutive patients with ICH (≧30 mL in basal ganglia within 24 hours of ictus) were non-randomly assigned to receive MIPD (group A) or DC (group B) hematoma evacuation. The primary outcome was death at 30 days after onset. Functional independence was assessed at 1 year using the Glasgow Outcome Scale.ResultsA total of 198 patients met the per protocol analysis (84 in group A and 114 in group B). The initial Glasgow Coma Scale (GCS) score was 8.1 ± 3.4 and the National Institutes of Health Stroke Scale (NIHSS) score was 20.8 ± 5.3. The mean hematoma volume (HV) was 56.7 ± 23.0 mL, and there was extended intraventricular hemorrhage (IVH) in 134 patients. There were no significant intergroup differences in the above baseline data, except group A had a higher mean age than that of group B (59.4 ± 14.5 vs. 55.3 ± 11.1 years, P = 0.025).The cumulative mortalities at 30 days and 1 year were 32.3% and 43.4%, respectively, and there were no significant differences between groups A and B. However, the mortality for patients ≦60 years, NIHSS < 15 or HV≦60 mL was significantly lower in group A than that in group B (all P < 0.05). The cumulative functional independence at 1 year was 26.8%, and the difference between group A (33/84, 39.3%) and group B (20/114, 17.5%) was significant (P = 0.001).Multivariate logistic regression analysis showed that a favorable outcome after 1 year was associated with the difference in therapies, age, GCS, HV, IVH and pulmonary infection (all P <0.05).ConclusionsFor patients with hypertensive spontaneous ICH (HV≧30 mL in basal ganglia), MIPD may be a more effective treatment than DC, as assessed by a higher rate of functional independence at 1 year after onset as well as reduced mortality in patients ≦60 years of age, NIHSS < 15 or HV≦60 mL.

Highlights

The treatment of hypertensive spontaneous intracranial hemorrhage (ICH) is still controversial
Hypertensive intracranial hemorrhage (ICH) in the area of the basal ganglia accounts for 50-70% of all spontaneous ICH, and mortality at 30 days after onset is 33.3% to 50.6%, [1,2] while 41% of survivors has some degree of disability [3]
Inclusion criteria Patients were eligible for the study if they had a hypertensive spontaneous ICH in the basal ganglia with a hematoma volume (HV) ≧30 mL, the hematoma evacuation could start within 24 hours of ictus, and the informed consent for the operation could be obtained from patient’s relative or guardian

Summary

Introduction

The treatment of hypertensive spontaneous intracranial hemorrhage (ICH) is still controversial. The largest prospective randomized study, the STICH trial [5], with 1033 patients from 107 centers over an 8-year period, indicated that surgical evacuation did not appear to be helpful in treating supratentorial ICH. The STICH II trial [6] was recently completed using including 601 conscious patients with superficial lobar intracerebral hemorrhages (10–100 mL) and without intraventricular hemorrhage, who received either early surgery or conservative treatment in a ratio of 1:1. This trial showed no significant outcome differences at 6 moths between the two groups

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