Surgical treatment for large spontaneous basal ganglia hemorrhage: retrospective analysis of 253 cases

Abstract

Objectives. Spontaneous intracerebral hemorrhage (ICH) is a challenge to both neurologists and neurosurgeons. We aim to summarize the surgical treatment of ICH based on retrospective analysis of our patients. Methods. Two hundred and fifty-three patients with spontaneous ICH from August 2008 to August 2011 were retrospectively analyzed. Clinical data, including preoperative ICH score, pre- and postoperative GCS score, hematoma volume, postoperative brain infarction, 30-day mortality, and GOS 3 months postictus, were collected. One hundred and fifty patients had their intracranial pressure (ICP) monitored, and data were recorded and analyzed. All patients underwent craniotomy and clot removal under general anesthesia. Outcome analysis was stratified using hematoma volume, ICH score, preoperative GCS score, and decompressive craniectomy (DC). Results. The mean hematoma volume was 70.8 mL, and 68 patients (26.9%) underwent DC. The mean postoperative ICP was 28.8 ± 6.7 mmHg for patients without DC, and only 17.5 ± 8.6 mmHg for patients with DC. Twenty-five patients (9.9%) died within 30 days of operation, and 88 patients (34.8%, GOS ≥ 4) had good outcome 3 months after surgery. ICH volume > 50 mL, preoperative GCS score ≤ 8, and ICH score ≥ 3 are risk factors for unfavorable outcomes. Conclusions. DC can be used for patients with low preoperative GCS score, and it effectively reduces ICP and 30-day mortality. Hematoma volume, preoperative GCS score, and ICH score are of predictive value for surgical outcome of large basal ganglia hemorrhage.