Effect of minimally invasive procedures on motor function changes and nerve fibers of internal capsule in patients with thalamic hematoma

Abstract

Objective To observe the changes of nerve fibers of internal capsule and motor function in patients with thalamic hematoma treated by minimally invasive procedures using diffusion tensor imaging (DTI).Methods Twenty-two patients with thalamic hematoma were randomized into minimally invasive treatment group (MI group) and medication treatment group (MT group).The patients in MT group were given conventional medical treatment,and those in MI group were performed intracranial hematoma elimination by the minimally invasive procedures within 24 h of admission and medical treatment was also given.The patients in both MI group and MT group underwent a whole-brain DTI on admission and 2 weeks after the admission.The integrity of corticospinal tract (CST) in the internal capsule ipsilateral to the hematoma side and the contralateral side and their fractional anisotropy (FA) values were determined.The modified National Institutes of Health Stroke Scale (mNIHSS) were performed on admission,2 weeks and 1 month after onset of initial hemorrhage.Results DTI showed that fibers in the internal capsule ipsilateral to the hematoma either decreased in number or interrupted because of hematoma-induced damages in both groups,and the CST FA values on admission were significantly lower (0.432±0.022 and 0.410±0.028 for MI and MT groups,respectively) than the control values.The number of fibers and the FA values of CST in the internal capsule 2 weeks after the hematoma being evacuated were increased significantly as compared with those on admission.As FA values of CST in internal capsule increased,the mNIHSS scores decreased after the surgery and the motor function improved gradually.Conclusion Minimally invasive procedures for thalamic hematoma evacuation can effectively reduce the degree of injury to the motor function,and DTI can observe the changes of CST after the surgery directly. Key words: Thalamic hematoma; Corticospinal tract; Diffusion tensor imaging; Fractional anisotropy values