title: Large traumatic basal ganglia hematoma: surgical treatment versus conservative management.
abstract: BACKGROUND
  Traumatic basal ganglia hematomas (TBGHs) are uncommon events in patients with closed head injuries. The overall prognosis is poor, particularly when large hematoma exists. This study was designed to compare surgical evacuation through transsylvian-transinsular approach with conservative management in large TBGHs.
  
  
  METHODS
  Thirty-two patients, admitted between July 2002 and July 2013, with closed head injury and TBGH more than 25 mL were included in this study. Among these patients, sixteen were conservatively managed whereas another sixteen patients underwent hematoma evacuation via transsylvian-transinsular approach. The modified Rankin scale was used to assess the functional outcomes of patients for at least 6 months after treatment.
  
  
  RESULTS
  There were no significant differences between two groups with respect to age (21.0 vs. 18.9 years, P=0.635), sex (P=0.220), and admission GCS Score (7.5 vs. 6.5, P=0.234). The patients treated with surgical approach revealed a better functional outcome compared to the conservative group (68.8% vs. 31.3%, P=0.043). The mean of late TBGH volume in the conservative group was less than surgical group (33.9 mL vs. 40.0 mL, P=0.047). The mortality rates were not significantly different between the surgical and conservative groups (18.8% vs. 37.5%, P=1.000).
  
  
  CONCLUSIONS
  This study suggests that hematoma evacuation through a transsylvian-transinsular approach improves the functional outcome in patients with TBGH.
authors.affiliation: Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Humain
authors.initials: H
authors.lastname: Baharvahdat
authors.affiliation: Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Babak
authors.initials: B
authors.lastname: Ganjifar
authors.affiliation: Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Etemadrezaie
authors.affiliation: Shefa Neuroscience Research Center, Khatam-Alanbia Hospital, Tehran, Iran - gorjial@uni-muenster.de.|Department of Neuroscience, Mashhad University of Medical Sciences, Mashhad, Iran.|Department of Neurosurgery and Neurology, Epilepsy Research Center, Westfälische Wilhelms-Universität Münster, Münster, Germany.
authors.forename: Ali
authors.initials: A
authors.lastname: Gorji
mesh_terms: D000328:Adult; D001479:Basal Ganglia / Q000601:surgery*; D020145:Basal Ganglia Hemorrhage / Q000601:surgery*; D000072700:Conservative Treatment; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006973:Hypertension / Q000601:surgery*; D008297:Male; D016896:Treatment Outcome