Tubular versus stereotactic evacuation of medium- to large-sized supratentorial spontaneous intra cerebral hematoma

摘要

Primary intracerebral hemorrhage due to hypertension or amyloid angiopathy is a major catastrophe to the brain especially in old age. It forms 20–30% of all strokes. Open craniotomy for evacuation of the hematoma may not be applicable in some patients with uncontrolled blood pressure and bad general conditions that do not permit general anesthesia. This study investigated the safety and efficacy of two minimally invasive procedures in the evacuation of spontaneous hypertensive medium to large intracerebral hematomas. This is a retrospective study during the period from June 2008 to December 2016; 36 patients suffering from hypertensive intracerebral hematoma were investigated, operated upon, and followed up for at least 1 year. The hematomas were evacuated by CT-guided stereotactic procedures in 18 patients and by microscopic assisted tubular approach in the other 18 patients. The age of patients ranged from 48 to 79 years. There were 26 males and 10 females included in the study. GCS on presentation was 8–13. In patients of the tubular group (15 males + 3females), the total mortality was 4 patients and 14 patients experienced different degrees of improvement: 3 patients were conscious with no deficits and good recovery, 9 patients were conscious with mild disability, and 2 patients were conscious with severe disability. The final results in patients (11 males + 7 females) managed by stereotactic resection and thrombolysis of the hematoma after the follow-up period were as follows: 5 patients died, 1 patient was conscious with severe disability, 10 patients were conscious with mild disability, and 2 patients were conscious with complete recovery. Minimally invasive hematoma resection procedures have advantages of reducing time and amount of surgical stress, the possibility of doing them under local anesthesia, facility of earlier evacuation, and reduced tissue trauma. Performing the procedures under image monitoring may be helpful in anticipating and detecting intraoperative accidents. Stereotactic aspiration is still helpful in chronic stage, where the clot becomes liquefied and easy for simple aspiration. This makes rehabilitation easier and further deterioration avoidable.