title: Extensive basal ganglia hematomas treated by local thrombolysis versus conservative management - a comparative retrospective analysis.
abstract: OBJECTIVE
  Single-target puncture plus catheter insertion into the clot is a routine step in hematoma aspiration and local thrombolysis for spontaneous intracerebral haemorrhage (ICH). However, multiple-target puncture of this procedure may imply faster hematoma reduction for large-area ICH. We retrospectively examined the outcomes after clot aspiration plus local thrombolysis with single-/double-target and conservative therapy for extensive basal ganglic hematomas.
  
  
  METHODS
  A case note review was conducted on a consecutive series of ICH patients in a single centre with huge basal ganglia hematomas who underwent clots aspiration and thrombolysis or pure medical therapy. We analysed the clinical presentation, radiological features and treatment outcomes of ICH patients in single-target group, double-target group and conservative group.
  
  
  RESULTS
  A total of 92 ICH cases were included in this study. At the post-treatment assessment, the average level by hematoma size in single-target and double-group was respectively smaller than that in the conservative group (20.61 ml vs. 15.75 ml vs 60.53 ml, p < 0.01). The 30-day case fatality rate in conservative group was respectively significantly higher than that in single-target and double-target groups (50% vs. 14.70% vs. 20.59%, p < 0.01). At the time of 6-month follow-up, the proportion of good survival in conservative group was respectively remarkably less than that in single- and double-target group (29.17% vs.64.71% vs. 67.65%, p < 0.01). But no difference was detected with respect to 30-day mortality or long-time outcome between the two micro-invasive groups (p = 0.53 and 0.798, respectively).
  
  
  CONCLUSIONS
  Our data suggested for the massive basal ganglia hematomas, clot aspiration and thrombolysis can improve the short- and long-term prognosis compared with the pure conservative therapy. But, no evidence was found to demonstrate double-target of this procedure to be more effective than single-target to improve the outcome.
authors.affiliation: a Neurology Department , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China.
authors.forename: Feng
authors.initials: F
authors.lastname: Xu
authors.affiliation: a Neurology Department , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China.
authors.forename: Lifei
authors.initials: L
authors.lastname: Lian
authors.affiliation: a Neurology Department , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China.
authors.forename: Qiming
authors.initials: Q
authors.lastname: Liang
authors.affiliation: a Neurology Department , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China.
authors.forename: Wenhao
authors.initials: W
authors.lastname: Zhu
authors.affiliation: a Neurology Department , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Liu
authors.affiliation: a Neurology Department , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China.
authors.forename: Huicong
authors.initials: H
authors.lastname: Kang
authors.affiliation: a Neurology Department , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China.
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.affiliation: a Neurology Department , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China.
authors.forename: Furong
authors.initials: F
authors.lastname: Wang
authors.affiliation: a Neurology Department , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Xue
authors.affiliation: a Neurology Department , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China.
authors.forename: Zhouping
authors.initials: Z
authors.lastname: Tang
authors.affiliation: a Neurology Department , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China.
authors.forename: Suiqiang
authors.initials: S
authors.lastname: Zhu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D020145:Basal Ganglia Hemorrhage / Q000188:drug therapy* / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000188:drug therapy* / Q000601:surgery; D000072700:Conservative Treatment / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Intracerebral haemorrhage; minimally invasive surgery; multiple-target; neurocritical; re-bleeding; thrombolysis