Efficacy comparison of different surgical timing and approaches of hypertensive cerebral hemorrhage in the basal ganglia

Abstract

Objective To investigate the effects of surgical timing and approaches on the treatment outcomes of hypertensive cerebral hemorrhage in the basal ganglia. Methods The clinical data of 223 patients with hypertensive cerebral hemorrhage in the basal ganglia, who underwent operations at Department of Neurosurgery, the People's Hospital of Xinjiang Uygur Autonomous Region from January 2010 to September 2015, were retrospectively analyzed. Based on the time from illness onset to surgery, these patients were divided into 3 groups: the ultra-early group (≤ 7 h, n=75), early group(> 7-24 h, n=109), and delayed group (> 24 h, n=39). According to different surgical approaches, patients were also divided into 2 groups including the craniotomy group in which 107 cases were treated with craniotomy with bone flap and minimally invasive group in which 116 patients underwent minimally invasive puncture and drainage. Evaluation with the activities of daily living (ADL) grade was conducted at 7 days and 3 month post surgery for all patients. Results The modified ADL scores demonstrated that the excellent rate at 7 days post surgery in the ultra-early group was 89.3% and significantly higher than those in the early group (62.3%) and delayed group (56.4%) (both P 0.05). Conclusions The prognosis of patients with hypertensive hemorrhage in the basal ganglia undergoing ultra-early surgical management seems to be better than those undergoing early or delayed operations. The treatment of craniotomy could lead to better perioperative periool outcomes and similar short-term results compared with the minimally invasive procedure for hematoma removal. Key words: Hypertensive cerebral hemorrhage; Basal ganglia; Prognosis; Timing of surgery; Surgical approach