Optimal treatment determination on the basis of haematoma volume and intra-cerebral haemorrhage score in patients with hypertensive putaminal haemorrhages: a retrospective analysis of 310 patients.

Hao Liu,Hao Li,Jianguo Xu,Jin Li,Yunhui Zen,Chao You,Xiang Wang

doi:10.1186/1471-2377-14-141

Abstract

BackgroundHypertensive putaminal haemorrhage comprises major part of intra-cerebral haemorrhages, with particularly high morbidity and mortality. However, the optimal treatments for these individuals remain controversial.MethodsFrom June 2010 to August 2013, patients with hypertensive putaminal haemorrhages were treated in the Department of Neurosurgery, West China Hospital. Information regarding the age, signs of cerebral herniation, haematoma volume, intra-ventricular haemorrhage, intra-cerebral haemorrhage score and the treatments of each patient were analyzed retrospectively. The outcome was evaluated by the 30-day mortality rate.ResultsThe 30-day mortality rate of the patients with haematomas volume greater than or equal to 30 ml and intra-cerebral haemorrhage scores of 1 or 2 was decreased in the surgical group compared with those in the conservative group (1.92% VS. 21.40%, OR = 0.072, p = 0.028; 15.40% VS. 33.3%, OR = 0.365, p = 0.248, respectively). The mortality rate of the patients with signs of cerebral herniation was not significantly different between the surgical and conservative groups (83.30% VS. 100%; p = 0.529). The intra-cerebral haemorrhage score was significantly associated with the 30-day mortality rate of patients with intra-cerebral haemorrhages (r = -0.798, p < 0.001).ConclusionPatients with basal ganglia haematomas volume greater than or equal to 30 ml and intra-cerebral haemorrhage scores of 1 or 2 could benefit from the surgical removal of haematomas. The intra-cerebral haemorrhage score can accurately predict the 30-day mortality rate of patients with hypertensive putaminal haemorrhages.

Highlights

Hypertensive putaminal haemorrhage comprises major part of intra-cerebral haemorrhages, with high morbidity and mortality
The Surgical Trial in Intracerebral haemorrhage (STICH) has shown that there is no significant benefit of early surgery compared with initial conservative treatment in patients with spontaneous intra-cerebral haemorrhage (ICH) [5], trials in Japan have shown that early surgery can improve the mortality of patients with spontaneous ICHs [6]
We conducted a retrospective study to investigate whether the patients with hypertensive putaminal haemorrhages who can benefit from the surgical removal of haematomas on the basis of the haematoma volume and ICH score

Summary

Introduction

Hypertensive putaminal haemorrhage comprises major part of intra-cerebral haemorrhages, with high morbidity and mortality. Haematomas within the basal ganglia comprise 60% of all cases with hypertensive ICHs, and these cases have a high morbidity and mortality despite optimized treatments [2]. The role of surgical and medical therapy in treating putaminal haemorrhage remains controversial. We believed that a subset of patients with basal ganglia haemorrhages could benefit from the micro-surgical evacuation of haematomas. There are no existing data regarding treatment selection on the basis of haematoma volume and the ICH score of patients with basal ganglia haemorrhages. We conducted a retrospective study to investigate whether the patients with hypertensive putaminal haemorrhages who can benefit from the surgical removal of haematomas on the basis of the haematoma volume and ICH score

Methods

Results

Conclusion