Hematoma Evacuation via Image-Guided Para-Corticospinal Tract Approach in Patients With Spontaneous Intracerebral Hemorrhage

Abstract

Background: Corticospinal tract injury from conventional craniotomy might influence the outcomes of intracerebral hemorrhage (ICH). The aim of the study was to evaluate the safety and efficacy of hematoma evacuation via image-guided para-corticospinal tract approach. Methods: Seventy-five ICH patients who underwent the image-guided para-corticospinal tract approach were retrospectively collected into surgery group. Diffusion tensor imaging (DTI) or CT angiography (CTA) was performed to identify the relationship of important white matter tracts and hematoma. The neuronavigation system where the preoperative imaging data is loaded was used to identify the burr hole location, and depth of insertion. The approach was introduced into the sulcus under navigation guidance and parallel to the CST into the hematoma along the trajectory chosen. Hematoma was removed under the image-guided para-corticospinal tract approach. Seventy-five age-, sex-, hematoma site- and volume-matched ICH patients who underwent conservative treatment were randomly selected as controls. Demographical, clinical, radiological and treatment-related data of patients were analyzed retrospectively. Functional outcome was evaluated by modified Rankin Scale at 90 days. Findings: 150 patients were retrospectively collected. The median Glasgow Coma Scale (GCS) score on admission was 11 (range, 5-15). The percent of thalamus/basal ganglion regions were 86.7% (130 patients). The mean hematoma volume was 47 ± 19 mL. A higher proportion of favorable patients was observed in surgery group than conservative treatment group (32.0% versus 17.4%; P=0.037). Interpretation: Hematoma evacuation via image-guided para-corticospinal tract approach seems to be safe in ICH patients with a relatively high functional independence. Funding: The ministry of science and technology of China and Southwest Hospital. Declaration of Interest: All authors declare that they have no conflicts of interest. Ethical Approval: This retrospective trial was approved by the Southwest Hospital. Ethics approval was obtained from the Ethics Committee of the Southwest Hospital of Third Military Medical University.