title: Difference of injury of the corticospinal tract according to surgical or conservative treatment in patients with putaminal hemorrhage.
abstract: OBJECTIVE
  We investigated difference of injury of the corticospinal tract (CST) according to surgical or conservative treatment in patients with putaminal hemorrhage (PH), using diffusion tensor tractography (DTT).
  
  
  METHODS
  Forty-six patients with PH (hematoma volume on the brain CT: 20-40 ml) were recruited. Patients were classified as the surgical treatment group and the conservative treatment group. The hematoma volume on the initial brain CT (median 2 hours after onset; range 1-14 hours) and volumes of the hematoma, the total lesion and the peri-hematomal edema volume on the follow-up brain magnetic resonance imaging (MRI) (median 23.5 days after onset; range 12-46 days) were estimated. Diffusion tensor imaging was performed and we defined the injury of the CST in terms of the configuration or abnormal DTT parameters.
  
  
  RESULTS
  In the conservative treatment group, the total lesion volume on the brain MRI was increased compared with the hematoma volume on the initial brain CT (p < 0.05). On brain MRI, the hematoma volume, peri-hematomal edema volume, and total lesion volume were larger in the conservative treatment group than in the surgical treatment group (p < 0.05). Twelve patients (60%) in the surgical treatment group and 24 patients (92%) in the conservative treatment group had injury of the CST.
  
  
  CONCLUSIONS
  Injury of the CST was less prevalent in the surgical treatment group than in the conservative treatment group in patients with PH. Therefore, it appears that surgical treatment could be helpful in prevention of injury of the CST in patients with PH.
authors.affiliation: a Department of Physical Medicine and Rehabilitation, College of Medicine , Yeungnam University , Daegu , Republic of Korea.
authors.forename: Ah Young
authors.initials: AY
authors.lastname: Lee
authors.affiliation: b Department of Neurosurgery, College of Medicine , Yeungnam University , Daegu , Republic of Korea.
authors.forename: Byung Yun
authors.initials: BY
authors.lastname: Choi
authors.affiliation: b Department of Neurosurgery, College of Medicine , Yeungnam University , Daegu , Republic of Korea.
authors.forename: Seong Ho
authors.initials: SH
authors.lastname: Kim
authors.affiliation: b Department of Neurosurgery, College of Medicine , Yeungnam University , Daegu , Republic of Korea.
authors.forename: Chul Hoon
authors.initials: CH
authors.lastname: Chang
authors.affiliation: b Department of Neurosurgery, College of Medicine , Yeungnam University , Daegu , Republic of Korea.
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Jung
authors.affiliation: a Department of Physical Medicine and Rehabilitation, College of Medicine , Yeungnam University , Daegu , Republic of Korea.
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Jang
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology*; D017115:Catheter Ablation / Q000379:methods*; D003399:Craniotomy; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D020146:Putaminal Hemorrhage / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D011712:Pyramidal Tracts / Q000473:pathology*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: KEYWORDS: putaminal hemorrhage; corticospinal tract; diffusion tensor imaging; hematoma volume; peri-hematomal edema