Can minimally invasive puncture and drainage for hypertensive spontaneous Basal Ganglia intracerebral hemorrhage improve patient outcome: a prospective non-randomized comparative study.
BACKGROUND
The treatment of hypertensive spontaneous intracranial hemorrhage (ICH) is still controversial. The purpose of the present study was to investigate whether minimally invasive puncture and drainage (MIPD) could improve patient outcome compared with decompressive craniectomy (DC).


METHODS
Consecutive patients with ICH (≧30 mL in basal ganglia within 24 hours of ictus) were non-randomly assigned to receive MIPD (group A) or DC (group B) hematoma evacuation. The primary outcome was death at 30 days after onset. Functional independence was assessed at 1 year using the Glasgow Outcome Scale.


RESULTS
A total of 198 patients met the per protocol analysis (84 in group A and 114 in group B). The initial Glasgow Coma Scale (GCS) score was 8.1 ± 3.4 and the National Institutes of Health Stroke Scale (NIHSS) score was 20.8 ± 5.3. The mean hematoma volume (HV) was 56.7 ± 23.0 mL, and there was extended intraventricular hemorrhage (IVH) in 134 patients. There were no significant intergroup differences in the above baseline data, except group A had a higher mean age than that of group B (59.4 ± 14.5 vs. 55.3 ± 11.1 years, P = 0.025). The cumulative mortalities at 30 days and 1 year were 32.3% and 43.4%, respectively, and there were no significant differences between groups A and B. However, the mortality for patients ≦60 years, NIHSS < 15 or HV≦60 mL was significantly lower in group A than that in group B (all P < 0.05). The cumulative functional independence at 1 year was 26.8%, and the difference between group A (33/84, 39.3%) and group B (20/114, 17.5%) was significant (P = 0.001). Multivariate logistic regression analysis showed that a favorable outcome after 1 year was associated with the difference in therapies, age, GCS, HV, IVH and pulmonary infection (all P <0.05).


CONCLUSIONS
For patients with hypertensive spontaneous ICH (HV≧30 mL in basal ganglia), MIPD may be a more effective treatment than DC, as assessed by a higher rate of functional independence at 1 year after onset as well as reduced mortality in patients ≦60 years of age, NIHSS < 15 or HV≦60 mL.
Department of Neurology, General Hospital of Beijing Command, Beijing, 100700 China.
Guo-Qiang
GQ
Wang
Department of Neurology, Xianghe Hospital of Traditional Chinese Medicine, Xianghe County, Hebei Province 654000 China.
Shi-Qiang
SQ
Li
Department of Neurology, General Hospital of Beijing Command, Beijing, 100700 China.
Yong-Hua
YH
Huang
Department of Neurology, General Hospital of Beijing Command, Beijing, 100700 China.
Wei-Wei
WW
Zhang
Department of Neurology, Xianghe Hospital of Traditional Chinese Medicine, Xianghe County, Hebei Province 654000 China.
Wen-Wei
WW
Ruan
Department of Neurosurgery, General Hospital of Beijing Command, Beijing, 100700 China.
Jia-Zhen
JZ
Qin
Department of Neurology, General Hospital of Beijing Command, Beijing, 100700 China.
Ying
Y
Li
Department of Neurology, General Hospital of Beijing Command, Beijing, 100700 China.
Wei-Min
WM
Yin
Department of Neurosurgery, General Hospital of Beijing Command, Beijing, 100700 China.
Yun-Jun
YJ
Li
Department of Neurology, Xianghe Hospital of Traditional Chinese Medicine, Xianghe County, Hebei Province 654000 China.
Zheng-Jun
ZJ
Ren
Department of Neurology, Xianghe Hospital of Traditional Chinese Medicine, Xianghe County, Hebei Province 654000 China.
Ji-Qiang
JQ
Zhu
Department of Neurology, Xianghe Hospital of Traditional Chinese Medicine, Xianghe County, Hebei Province 654000 China.
Yun-Yan
YY
Ding
Department of Neurology, Xianghe Hospital of Traditional Chinese Medicine, Xianghe County, Hebei Province 654000 China.
Jun-Qi
JQ
Peng
Department of Neurosurgery, General Hospital of Beijing Command, Beijing, 100700 China.
Pei-Jian
PJ
Li
Decompressive craniectomy; Intracerebral hemorrhage; Intraventricular hemorrhage; Minimal invasive puncture; Recombinant tissue plasminogen activator; Urokinase