The role of haematoma aspiration in the management of patients with thalamic haemorrhage: a pilot study with continuous compliance monitoring.

Abstract

Thalamic brain haemorrhage is a common disabling and potentially fatal condition. Management is mainly supportive and very rarely do neurosurgeons have to resort to evacuation of the haematoma. We hypothesised that haematoma aspiration may help to improve the outcome of the group of patients with thalamic haemorrhage. Patients with thalamic haemorrhage were selected on clinical group (intraventricular haemorrhage, hydrocephalus and haematoma size > 15 ml) for intracranial pressure (ICP) monitoring and management in the intensive care unit (ICU). A Spiegelberg double lumen intraventricular balloon catheter was inserted as a fluid-filled catheter on the side of the haematoma. Data of ICP, arterial blood pressure (ABP), cerebral perfusion pressure (CPP) and compliance were collected at one-minute intervals. Hourly averages were used for analysis. 94,448 set of data were collected from eight patients with thalamic haemorrhage. Significant reduction in ICP and improvement in intracranial compliance were detected. In patients with haematoma aspiration, intracranial compliance was improved within 48 hours of the procedure whereas ICP did not. This pilot study showed that haematoma aspiration in patients with thalamic haemorrhage could improve intracranial compliance. Whether this could be translated into clinical outcome benefits requires further study in a larger number of patients.