title: Factors affecting the evacuation rate of intracerebral hemorrhage in basal ganglia treated by minimally invasive craniopuncture.
abstract: OBJECTIVE
  Minimally invasive craniopuncture has been used to treat intracerebral hemorrhage (ICH) for over 20 years in China. However, one-off total evacuation of hematoma cannot be achieved through this procedure because it is not an open surgery. This study is designed to identify factors that can increase the hematoma evacuation rate (ER) of this procedure and to evaluate the influence of ER on long-term outcome.
  
  
  METHODS
  A total of 309 patients with basal ganglia ICH treated by minimally invasive craniopuncture were analyzed retrospectively. Univariate and multivariate linear regression analyses were used to identify factors correlated with a high ER. The correlation between ER and long-term outcome was also analyzed by logistic regression and the Spearman correlation.
  
  
  RESULTS
  A low hematoma mean CT number (β=-0.773, p<0.001) and postoperative cerebrospinal fluid (CSF) outflow (β=0.193, p<0.001) were found to be independent factors associated with a high ER. In patients with 30-50ml of hematoma, a high ER was correlated with a high Barthel index improvement (r=0.611, p<0.001) and a high modified Rankin scale decline (r=0.517, p<0.001). In patients with 50-80ml of hematoma, a high ER was a protective factor of case fatality (B=-2.297, p=0.005).
  
  
  CONCLUSIONS
  The hematoma mean CT number can predict the efficiency of minimally invasive craniopuncture in patients with ICH. In patients with ventricular involvement, the tip of the puncture needle should be placed close to the tear in the ventricle rather than at the center of the hematoma to facilitate postoperative CSF outflow.
authors.affiliation: Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Chongshandong Road 4, Shenyang, Liaoning 110032, China. Electronic address: wangtingzhong@126.com.
authors.forename: Tingzhong
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Chongshandong Road 4, Shenyang, Liaoning 110032, China.
authors.forename: Yongchang
authors.initials: Y
authors.lastname: Guan
authors.affiliation: Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Chongshandong Road 4, Shenyang, Liaoning 110032, China.
authors.forename: Jinghua
authors.initials: J
authors.lastname: Du
authors.affiliation: Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Chongshandong Road 4, Shenyang, Liaoning 110032, China.
authors.forename: Guojun
authors.initials: G
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Chongshandong Road 4, Shenyang, Liaoning 110032, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Gao
authors.affiliation: Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Chongshandong Road 4, Shenyang, Liaoning 110032, China.
authors.forename: Xianlin
authors.initials: X
authors.lastname: Zhao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001479:Basal Ganglia / Q000000981:diagnostic imaging*; D020145:Basal Ganglia Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery; D002555:Cerebrospinal Fluid; D002681:China; D015331:Cohort Studies; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006406:Hematoma / Q000601:surgery*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D015999:Multivariate Analysis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: CT number; Hematoma evacuation rate; Intracerebral hemorrhage; Minimally invasive craniopuncture