Skip to main content
SpringerLink
Log in

Comparison of CT-guided aspiration to key hole craniotomy in the surgical treatment of spontaneous putaminal hemorrhage: a prospective randomized study

  • Research Article
  • Published:
Frontiers of Medicine in China Aims and scope Submit manuscript

Abstract

This study was designed to compare the approaches and efficacies of two different ways of neurosurgical management for spontaneous putaminal hemorrhage (SPH): computed tomographic-guided aspiration (CTGA) and the key-hole approach (KHA). The indications of the two approaches are also explored. From September 2001 to 2003, a total of 1077 cases of SPH distributed in 135 hospitals all over the mainland of China were included for analysis. All cases had three-month follow-up data. The study was designed in a single-blinded manner to compare the efficacies of the different approaches. There were 563 cases in the CTGA group, 165 in the KHA group, and 217 cases in the conventional open craniotomy (COC) group. In the CTGA and KHA groups, the mortalities at one month after operation (M1m) were 17.9% and 18.3%, respectively, while the mortalities at three months after operation (M3m) were 19.4% and 19.4%, respectively (P>0.05). The postoperative complications due to CTGA (23.7%) were not significantly different from those due to KHA (25.7%) (P = 0.420). The M3m of patients with Glasgow coma scale (GCS) ⩽8 was 3.45 and 4.0 times as much as those with GCS>8, respectively. The M3m of patients with complications was 3.92 times as much as those without complications. The M3m of patients with hemorrhage volume ⩾70 mL was 2.67 times as much as those <70 mL. The CTGA is not better than KHA in the treatment of SPH in terms of a more favorable outcome or less mortality and morbidity, but CTGA could be the first choice for those with bleeding volumes ≤50mL, while KHA is the first choice for those with bleeding volumes >50 mL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Fernandes H M, Mendelow AD. Spontaneous intracerebral haemorrhage: A surgical dilemma. Br J Neurosurg, 1999, 13(4): 389–394

    Article  CAS  PubMed  Google Scholar 

  2. Fernandes H M, Gregson B, Siddique S, Mendelow A D. Surgery in intracerebral hemorrhage: The uncertainty continues. Stroke, 2000, 31(10): 2511–2516

    Article  CAS  PubMed  Google Scholar 

  3. Hankey G J. Evacuation of intracerebral hematoma is likely to be beneficial-against. Stroke, 2003, 34(6): 1568–1569

    Article  PubMed  Google Scholar 

  4. Tan S H, Ng P Y, Yeo T T, Wong S H, Ong P L, Venketasubramanian N. Hypertensive basal ganglia hemorrhage: A prospective study comparing surgical and nonsurgical management. Surg Neurol, 2001, 56(5): 287–292; discussion 292–293

    Article  CAS  PubMed  Google Scholar 

  5. Hankey G J, Hon C. Surgery for primary intracerebral hemorrhage: is it safe and effective? A systematic review of case series and randomized trials. Stroke, 1997, 28(11): 2126–2132

    Article  CAS  PubMed  Google Scholar 

  6. Broderick J P, Adams H P Jr, Barsan W, Feinberg W, Feldmann E, Grotta J, Kase C, Krieger D, Mayberg M, Tilley B, Zabramski J M, Zuccarello M. Guidelines for the management of spontaneous intracerebral hemorrhage: A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke, 1999, 30(4): 905–915

    Article  CAS  PubMed  Google Scholar 

  7. Minematsu K. Evacuation of intracerebral hematoma is likely to be beneficial. Stroke, 2003, 34(6): 1567–1568

    Article  PubMed  Google Scholar 

  8. Grotta J C. Acute stroke therapy in the millennium: consummating the marriage between the laboratory and the bedside: The Feinberg lecture. Stroke, 1999, 30(8): 1722–1728

    Article  CAS  PubMed  Google Scholar 

  9. Chen X C, Yang H M, Chen Z P. The comparison of surgical and medical treatment of hypertensive cerebral hemorrhage. Fudan University Journal of Medical Sciences, 1992, 19(1): 237–240

    Google Scholar 

  10. Yoon S S, Byles J. Perceptions of stroke in the general public and patients with stroke: A qualitative study. Br Med J, 2002, 324(7345): 1065–1068

    Article  Google Scholar 

  11. Kadojic D, Barac B, Trkanjec Z, Kadojic M. The secular trend in the incidence of hemorrhagic stroke in the region of Osijek, Eastern Croatia in the period 1988—2000—a hospital based study. Coll Antropol, 2002, 26(2): 627–634

    CAS  PubMed  Google Scholar 

  12. Passero S, Ciacci G, Reale F. Potential triggering factors of intracerebral hemorrhage. Cerebrovasc Dis, 2001, 12(3): 220–227

    Article  CAS  PubMed  Google Scholar 

  13. Song E C, Chu K, Jeong S W. Hyperglycemia exacerbates brain edema and perihematomal cell death after intracerebral hemorrhage. Stroke, 2003, 34(9): 2215–2220

    Article  CAS  PubMed  Google Scholar 

  14. Cho S J, Won T K, Hwang S J, Kwon J H. Bilateral putaminal hemorrhage with cerebral edema in hyperglycemic hyperosmolar syndrome. Yonsei Med J, 2002, 43(4): 533–535

    PubMed  Google Scholar 

  15. Morgenstern L B, Demchuk A M, Kim D H, Frankowski R F, Grotta J C. Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage. Neurology, 2001, 56(10): 1294–1299

    Article  CAS  PubMed  Google Scholar 

  16. Rabinstein A A, Atkinson J L, Widjicks E F M. Emergency craniotomy in patients worsening due to expanded cerebral hema-toma: to what purpose? Neurology, 2002, 58(9): 1367–1372

    Article  PubMed  Google Scholar 

  17. Nasser J A, Falavigna A, Bezerra M, Martinez V, Freitas G, Alaminos A, Bonatelli A, Ferraz F. Stereotactic fibrinolysis of spontaneous intracerebral hematoma using infusion of recombinant tissue plasminogen activator. Arq Neuropsiquiatr, 2002, 60(2B): 362–366

    Article  PubMed  Google Scholar 

  18. Montes J M, Wong J H, Fayad P B, Fayad P B, Awad I A. Stereotactic computed tomographic-guided aspiration and thrombolysis of intracerebral hematoma: Protocol and preliminary experience. Stroke, 2000, 31(4): 834–840

    Article  CAS  PubMed  Google Scholar 

  19. Bernays R L, Kollias S S, Romanowski B, Valavanis A, Yonekawa Y. Near-real-time guidance using intraoperative magnetic resonance imaging for radical evacuation of hypertensive hematomas in the basal ganglia. Neurosurgery, 2000, 47(5): 1081–1089; discussion 1089–1090

    Article  CAS  PubMed  Google Scholar 

  20. Phan T G, Koh M, Vierkant R A. Hydrocephalus is a determinant of early mortality in putaminal hemorrhage. Stroke, 2000, 31: 2157–2162

    Article  CAS  PubMed  Google Scholar 

  21. Klungel O H, Stricker B H, Paes A H, Seidell J C, Bakker A, Vok Z, Breteler M M, de Anthonius B. Excess stroke among hypertensive men and women attributable to undertreatment of hypertension. Stroke, 1999, 30(7): 1312–1318

    Article  CAS  PubMed  Google Scholar 

  22. Bae H, Jeong D, Doh J, Lee K, Yun I, Byun B. Recurrence of bleeding in patients with hypertensive intracerebral hemorrhage. Cerebrovasc Dis, 1999, 9(2): 102–108

    Article  CAS  PubMed  Google Scholar 

  23. Sug Y S, Heller R F, Levi C, Wiggers J, Fitzgerald P E. Knowledge of stroke risk factors, warning symptoms, and treatment among an Australian urban population. Stroke, 2001, 32(8): 1926–1930

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital University of Medical Sciences, Beijing, 100050, China

    Zhao Jizong MD, Wang Dejiang MD, Wang Shuo MD, Yuan Ge MD, Kang Shuai MD, Ji Nan MD, Zhao Yuanli MD & Ye Xun MD

  2. Department of Neurosurgery, Hua Shan Hospital, Fudan University, Shanghai, 200040, China

    Zhou Liangfu MD

  3. Department of Neurosurgery, General Hospital of People’s Liberation Army, Beijing, 100853, China

    Zhou Dingbiao MD

  4. Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, 100730, China

    Wang Renzhi MD

  5. Institute of Hygienic Economics, Beijing, 100050, China

    Wang Mei PhD

Authors
  1. Zhao Jizong MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhou Liangfu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhou Dingbiao MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wang Renzhi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wang Mei PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wang Dejiang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wang Shuo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yuan Ge MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kang Shuai MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ji Nan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Zhao Yuanli MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ye Xun MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhao Jizong MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhao, J., Zhou, L., Zhou, D. et al. Comparison of CT-guided aspiration to key hole craniotomy in the surgical treatment of spontaneous putaminal hemorrhage: a prospective randomized study. Front. Med. China 1, 142–146 (2007). https://doi.org/10.1007/s11684-007-0027-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11684-007-0027-1

Keywords

Search

Navigation