Basal ganglia hematoma optimal treatment

The total 30-day mortality rate of patients with basal ganglia haematomas of 30 ml or more and ICH scores of 1 was significantly lower in the surgical group than in the conservative group. For the patients with ICH scores equal to 2, the 30-day mortality rate was obviously decreased in the surgical group compared with that that in the conservative group. It demonstrated that hematoma clot evacuation could limit the brain edema and local ischaemia.

The 30-day mortality rate of patients with basal ganglia haematomas volume of ≥ 30 ml and signs of brain herniation was up to 90% even the hematoma was evacuated surgically within 24 h after the ictus. In a study of Liu et al., 16 of 18 patients with signs of herniation died within 1 week. The possible explanation was that only removal of haematomas might be insufficient to relieve the increased intracranial hypertension. The intra-cranial hypertension would increase again to severe values in few hours because of brain swelling.

Furthermore, the patients with ICH scores equal to 3, the 30-day mortality rate was higher in the surgical group than in the conservative group. Therefore, Treatment should be individualised for patients with basal ganglia haemorrhages. The ICH score was highly associated with the 30-day mortality rate of patients with basal ganglia haemorrhages, which was similar to other studies.

Therefore, the ICH score would provide a standard assessment tool, which can be determined rapidly and easily, for treatments selection of patients with hypertensive basal ganglia haemorrhage.

This study demonstrated that surgical intervention would decrease the 30-day mortality rate of patients with hypertensive basal ganglia haematomas of ≥ 30 ml and ICH scores of 1 or 2. But this retrospective study had some limitations. The hematoma removal was through different surgical procedures. Some patients with large haematoma didn’t receive surgical intervention because of economy; However, a subset of patients with basal ganglia hematoma volume of < 30 ml and shift of midline ≥ 5 mm received surgical removal of hematoma. A more definitive conclusion will be achieved from the future trial 1).

1) Liu H, Zen Y, Li J, Wang X, Li H, Xu J, You C. 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. BMC Neurol. 2014 Jul 4;14:141. doi: 10.1186/1471-2377-14-141. PubMed PMID: 24996971; PubMed Central PMCID: PMC4090634.

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