Document Detail

The effects on prognosis of surgical treatment of hypertensive putaminal hematomas through transsylvian transinsular approach.
MedLine Citation:
PMID:  12681546     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Hypertensive putaminal hematoma (HPH) is a devastating type of stroke that mostly results in death or severe neurologic deficit. There seems to be no general agreement on the selection of treatment modality for individual patients. In this study a comparison has been made between conservative treatment and the results of surgical treatment through the transsylvian transinsular approach of HPH with 30 cc or more. METHODS: Sixty-six patients with 30 cc volume or over of HPH, who were admitted within 36 hours after ictus, have been included in this study. Selection of the patients was made primarily according to the computerized tomography scan (CT) findings on admission. Out of the 66 patients, 47 were operated for hematoma evacuation through transsylvian transinsular approach, and the remaining 19 were accepted as a control group to be treated conservatively after their relatives declined authorization for surgery. All patients' neurologic grades and CT findings on admission were classified according to the hypertensive intracerebral hemorrhage grading system, as proposed by the cooperative study in Japan. After 6 months the outcomes of both groups were assessed according to the Glasgow outcome scale (GOS). RESULTS: The statistical difference between the mortality rates was considerable (p < 0.05) with ratios of 34% and 63.1% in the surgically and conservatively treated groups, respectively. Good recovery, that is GOS score 5, was not observed in either group. In the group of surgically treated patients, 27.7% was eventually moderately disabled (GOS score 4); whereas this ratio was 5.3% among the conservatively treated group, giving a statistically significant difference (p < 0.05). Our results indicate that neurologic grades and CT findings on admission are good predictors of outcome, as the grades increase the outcome worsens. Furthermore, ventricular spread of hematoma is not a good prognostic factor. CONCLUSIONS: Surgical treatment via transsylvian transinsular approach of HPH with a volume of 30 cc or more results in improved outcome as compared to conservative treatment. Operation time within the first 36 hours after ictus did not affect the outcome.
R Alper Kaya; Osman Türkmenoğlu; Ibrahim M Ziyal; Türker Dalkiliç; Yüksel Sahin; Yunus Aydin
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  Surgical neurology     Volume:  59     ISSN:  0090-3019     ISO Abbreviation:  Surg Neurol     Publication Date:  2003 Mar 
Date Detail:
Created Date:  2003-04-08     Completed Date:  2003-05-08     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0367070     Medline TA:  Surg Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  176-83; discussion 183     Citation Subset:  IM    
Department of Neurosurgery, Sişli Etfal State Hospital, Göktürk Cad., Samat apt No: 46/14, Göktürk/Kemerburgaz, Istanbul, Turkey
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MeSH Terms
Cerebral Aqueduct / radiography,  surgery*
Cerebral Cortex / radiography,  surgery*
Glasgow Outcome Scale
Hypertension / mortality,  radiography,  surgery*
Middle Aged
Putaminal Hemorrhage / mortality,  radiography,  surgery*
Survival Rate
Time Factors
Tomography, X-Ray Computed

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

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