Document Detail


Impact of stereotactic hematoma evacuation on activities of daily living during the chronic period following spontaneous putaminal hemorrhage: a randomized study.
MedLine Citation:
PMID:  15352598     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: Stereotactic evacuation of hematoma has been reported to reduce the incidence of mortality and to improve functional outcome in patients with spontaneous putaminal hemorrhage. Stereotactic evacuation of hematoma has not been widely accepted as a standard therapy, however, because its effect on functional outcome has been regarded as marginal and there have been no randomized trials with sufficient statistical power to quantify the benefits of this procedure. The authors reassessed the value of stereotactic evacuation of hematoma by analyzing its impact on activities of living during the chronic period following spontaneous putaminal hemorrhage in a randomized study. METHODS: Four hundred ninety patients were entered into the study. The severity of their hemorrhages was graded neurologically on admission (neurological grades: 1, eyes are open; 2, eyes are closed but open to weak stimuli; 3, eyes are closed but open to strong stimuli; 4, eyes do not open but extremities move to stimuli; and 5, eyes do not open and extremities do not move to stimuli). Patients with Grade 2 and those with Grade 3 were randomized into two groups with different treatment protocols (Group I, stereotactic evacuation of the hematoma; and Group II, conservative treatment). Patients assigned neurological Grade 4 or 5 were excluded from the study because a large-scale retrospective study in Japan revealed that surgical treatment in patients assigned to these neurological grades does not improve functional outcome. Among the 490 patients, 242 were randomized strictly. This patient population comprised 148 men and 94 women ranging in age from 38 to 80 years (mean 60.5 years). Compared with Group II, Group I treatment resulted in a lower mortality rate and better recovery to functional independence in patients with neurological Grade 3. In patients with Grade 2, Group I treatment contributed to a better recovery of functional outcome and a lower mortality rate, but the difference was not significant. Multivariate analysis confirmed that stereotactic evacuation of the hematoma was contributory to a better recovery in functional outcome. CONCLUSIONS: Stereotactic evacuation of hematoma is clearly of value in selected patients with spontaneous putuminal hemorrhage, whose eyes are closed but will open in response to strong stimuli (neurological Grade 3) on admission.
Authors:
Naoyuki Hattori; Yoichi Katayama; Yoshio Maya; Alexander Gatherer
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  101     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2004-09-08     Completed Date:  2004-09-16     Revised Date:  2007-02-02    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  417-20     Citation Subset:  AIM; IM    
Affiliation:
Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
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MeSH Terms
Descriptor/Qualifier:
Activities of Daily Living / classification*
Adult
Aged
Aged, 80 and over
Chronic Disease
Female
Humans
Male
Middle Aged
Multivariate Analysis
Neurologic Examination / statistics & numerical data
Outcome and Process Assessment (Health Care) / statistics & numerical data
Postoperative Complications / etiology*
Prospective Studies
Putaminal Hemorrhage / surgery*
Stereotaxic Techniques*
Survival Rate
Tomography, X-Ray Computed
Comments/Corrections
Comment In:
J Neurosurg. 2006 Aug;105(2):338; author reply 338-9   [PMID:  17219845 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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