title: Benefits of adapting minimal invasive techniques to selected patients with spontaneous supratentorial intracerebral hematomas.
abstract: OBJECTIVE
  This study assesses the benefits of adapting minimal invasive techniques (MIT) to selected patients with spontaneous supratentorial intracerebral hematomas (SSICHs).
  
  
  METHODS
  The study compares the post-operative residual clot volume and clinical outcome of 89 selected, MIT evacuated SSICH-patients to those of 138 unselected cases operated in our department. Selection criteria includes patient age, early admission and MIT treatment. MIT treatment included: 28 patients with deep SSICHs smaller than 30 cm3 associated with intraventricular bleeding who underwent neuronavigation-guided stereotactic catheter lysis, 37 patients with deep hematomas larger than 30 cm3 and 24 patients with a lobar hemorrhage compressing eloquent regions who underwent microsurgical (endoscopic or neuronavigation assisted) clot aspiration.
  
  
  RESULTS
  In eight (9%) of the patients in the MIT group, the CT scan control showed a residual clot smaller than 30% of the initial hemorrhage. The neurological condition 3 months later revealed 24 (26.9%) of these patients having a severe disability and 46 (51.6%) patients independent or slightly disabled. Nineteen patients (21.9%) died or remained vegetative. In the control group, 48 (34.7%) cases showed residual clots (<30%). Sixty-two (44.9%) patients of this group were severely disabled and only 40 (28.9%) were independent. Thirty-six (26%) patients died or were vegetative. There was a p<0.001 significant difference in volume of residual clots as well as p<0.01 for the outcome between the two groups.
  
  
  CONCLUSIONS
  Adapting minimally invasive techniques to case selection improves the effectiveness of clot removal and the outcome of the patients with SSICHs.
authors.affiliation: Department of Neurosurgery, Städtische Kliniken, Frankfurt am Main Höchst, Germany. MCNievas@t-online.de
authors.forename: Mario Carvi
authors.initials: MC
authors.lastname: Y Nievas
authors.forename: Selim
authors.initials: S
authors.lastname: Toktamis
authors.forename: Eberhard
authors.initials: E
authors.lastname: Haas
authors.forename: Hans-Georg
authors.initials: HG
authors.lastname: Höllerhage
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D013238:Stereotaxic Techniques; D016896:Treatment Outcome