title: Borderline basal ganglia hemorrhage volume: patient selection for good clinical outcome after stereotactic catheter drainage.
abstract: OBJECTIVE The purpose of this study was to determine predisposing factors for good clinical outcome in patients with spontaneous basal ganglia hemorrhage with borderline volumes (defined as a hematoma volume between 20 and 50 cm3) who had undergone treatment by stereotactic catheter drainage. METHODS From the 298 patients whose information had been prospectively collected in the institutional database between January 2010 and December 2013, 93 patients were included in this retrospective study and divided into 2 groups: best medical treatment alone (Group A, n = 44) and best medical treatment plus catheterization (Group B, n = 49). All patients met the following criteria: 1) a diagnosis of spontaneous basal ganglia hemorrhage, and 2) a borderline hematoma volume (20 to 50 cm3). Postoperative modified Rankin Scale (mRS) scores and recovery of motor weakness were compared between the 2 groups, and predisposing factors for good clinical outcome were evaluated. RESULTS Patients in Group B showed earlier recovery of motor weakness and improved mRS scores than patients in Group A. The final mRS score at 12 months was better in Group B than in Group A (p = 0.006). Predisposing factors for a good clinical outcome were a hematoma volume < 30 cm3(OR 6.158, 95% CI 1.221-31.053, p = 0.028), an initial Glasgow Coma Scale (GCS) score ≥ 13 (OR 6.331, 95% CI 1.129-35.507, p = 0.036), the absence of internal capsule involvement (OR 4.680, 95% CI 1.152-19.010, p = 0.031), and catheterization (OR 13.376, 95% CI 2.423-73.842, p = 0.003) based on logistic regression analysis. CONCLUSIONS Good clinical outcome can be expected after stereotactic catheter drainage in patients with a hematoma volume between 20 and 30 cm3, an initial GCS score ≥ 13, and the absence of internal capsule involvement. Among these patients, stereotactic catheter drainage may have a beneficial effect on early recovery of motor weakness and functional outcome, indicating that lateral-type basal ganglia hematoma compression not involving the internal capsule may be better treated using stereotactic catheter drainage than treated medically.
authors: Department of Neurosurgery, Dongsan Medical Center, College of Medicine, Keimyung University, Daegu.
authors: Yeon Soo
authors: YS
authors: Choo
authors: Department of Neurosurgery, Gangnam Severance Hospital; and.|Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Joonho
authors: J
authors: Chung
authors: Department of Neurosurgery, Gangnam Severance Hospital; and.
authors: Jin-Yang
authors: JY
authors: Joo
authors: Department of Neurosurgery, Gangnam Severance Hospital; and.|Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Yong Bae
authors: YB
authors: Kim
authors: Department of Neurosurgery, Gangnam Severance Hospital; and.|Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Chang-Ki
authors: CK
authors: Hong
mesh_terms: D000328:Adult; D000368:Aged; D020145:Basal Ganglia Hemorrhage / Q000473:pathology*; D057785:Catheters; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D016896:Treatment Outcome
keywords: BP = blood pressure; EVD = external ventricular drainage; FNSC = frameless navigation-guided stereotactic catheter drainage; FUNC = functional outcome risk stratification scale; GCS = Glasgow Coma Scale; ICH = intracerebral hemorrhage; IVH = intraventricular hematoma; MAP = mean arterial pressure; NICU = neurosurgical intensive care unit; SBP = systolic blood pressure; STICH = Surgical Trial in Intracerebral Hemorrhage; basal ganglia hemorrhage; best medical treatment; intracerebral hemorrhage; mRS = modified Rankin Scale; minimally invasive surgery; predisposing factors; stereotactic catheter drainage; vascular disorders