Document Detail

Surgical treatment of thalamic hematomas via the contralateral transcallosal approach.
MedLine Citation:
PMID:  11485230     Owner:  NLM     Status:  MEDLINE    
Acute management of deep-seated hematomas remains controversial. Since patients with these hematoma later tend to develop severe edema and necrosis around the lesion, when surgery is indicated it should be done as early as possible. The purpose of this study was to compare whether early surgical removal and conservative treatment of primary thalamic hematoma correlated with improved neurological outcome. Last year, 61 patients with primary thalamic hematomas were admitted to our institution. Of these, 21 underwent surgery via contralateral transcallosal approach during the ultraearly stage (within 6 hours) after the apoplectic attack, and 24 patients were treated conservatively. Another 16 patients were excluded from the study due to systemic disease, mild hematoma (<40 cc), and deep coma associated with absence of brain stem reflexes. Initial Glasgow coma scores (GCS) at admission were similar for operated and nonoperated patients (8.64 +/- 1.93 versus 9.50 +/- 2.10, P>0.05). In the operated group, two patients had good recoveries and returned to normal life (Glasgow Outcome Score, or GOS, I), four had moderate disability and needed partial care (GOS II), six had severe disability and needed nursing care (GOS III), and six had a vegetative state (GOS IV). However, in the nonoperated group, one patient had good recovery and returned to normal life (GOS I), two had moderate disability and needed partial home care (GOS II), three had severe disability and needed nursing care (GOS III), and six had a vegetative state (GOS IV). In this group, the 30-day mortality rate was 50%. Mortality was markedly lower in the operated group (14.3%) than the nonoperated group. and this difference was statistically significant (chi2=3.33, P<0.05). From this study, we believe that evacuation of primary thalamic hematoma via the contralateral transcallosal microsurgical approach may be useful for deciding on the indication and predicting the functional prognosis.
A Kurtsoy; I S Oktem; R K Koc; A Menku; H Akdemir; B Tucer
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article    
Journal Detail:
Title:  Neurosurgical review     Volume:  24     ISSN:  0344-5607     ISO Abbreviation:  Neurosurg Rev     Publication Date:  2001 Jul 
Date Detail:
Created Date:  2001-08-03     Completed Date:  2001-12-07     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7908181     Medline TA:  Neurosurg Rev     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  108-13     Citation Subset:  IM    
Medical Faculty, Department of Neurosurgery, Erciyes University, Kayseri, Turkey.
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MeSH Terms
Activities of Daily Living
Anti-Inflammatory Agents / therapeutic use
Dexamethasone / therapeutic use*
Follow-Up Studies
Glasgow Outcome Scale
Hematoma / drug therapy,  mortality,  physiopathology,  surgery*
Length of Stay
Middle Aged
Recovery of Function
Thalamic Diseases / drug therapy,  mortality,  physiopathology,  surgery*
Time Factors
Treatment Outcome
Reg. No./Substance:
0/Anti-Inflammatory Agents; 50-02-2/Dexamethasone

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