Gross-total hematoma removal of hypertensive basal ganglia hemorrhages: A long-term follow-up

Zuo, Yi; Cheng, Gang; Gao, Dakuan; Zhang, Xiang; Zhen, Hai‐Ning; Zhang, Wei; Xiao, San-Chao

doi:10.1016/j.jns.2009.08.046

Cited by 26 publications

(19 citation statements)

References 33 publications

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“…Another set of clinical data showed that surgical treatment of hypertensive putaminal hematoma with 30 ml or more decreases mortality and provides better outcome compared with the non-operation group [100] . Burr hole craniectomy of hypertensive basal ganglia hemorrhage can decrease brain edema grades and reduce secondary injury by coagulation end productsactivated inflammatory cascade [101] . And the experiment showed that gross-total removal of hematoma group has a better outcome than the sub-total removal of the hematoma group; this indicates that residue hematoma can still promote secondary injury and may result in a comparatively worse result [101] .…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…Burr hole craniectomy of hypertensive basal ganglia hemorrhage can decrease brain edema grades and reduce secondary injury by coagulation end productsactivated inflammatory cascade [101] . And the experiment showed that gross-total removal of hematoma group has a better outcome than the sub-total removal of the hematoma group; this indicates that residue hematoma can still promote secondary injury and may result in a comparatively worse result [101] . However, a parallel-group trial about surgical trial in ICH (STICH) found that early surgery (within 24 h after onset) has no overall benefit compared with initial conservative treatment for spontaneous supratentorial ICH patients [102] .…”

Section: Surgical Treatmentmentioning

confidence: 99%

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Mechanism and Therapy of Brain Edema after Intracerebral Hemorrhage

et al. 2016

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Background: Intracerebral hemorrhage (ICH) is a subtype of stroke with a severe high mortality and disability rate and accounts for about 10-15% of all strokes. The oppression and destruction by hematoma to brain tissue cause the primary brain injury. The inflammation and coagulation response after ICH would accelerate the formation of brain edema around hematoma, resulting in a more severe and durable injury. Currently, treatments for ICH are focusing on the primary injury including reducing intracranial hypertension, blood pressure control, and rehabilitation. There is a short-of-effective medical treatment for secondary inflammation and reducing brain edema in ICH patients. So, it is very important to study on the relationship between brain edema and ICH. Summary: Many molecular and cellular mechanisms contribute to the formation and progress of brain edema after ICH; inhibition of brain edema provides favorable outcome of ICH. Key Messages: This review mainly discusses the pathology and mechanism of brain edema, the effects of brain edema on ICH, and the methods of treating brain edema after ICH.

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Section: Surgical Treatmentmentioning

confidence: 99%

Section: Surgical Treatmentmentioning

confidence: 99%

Mechanism and Therapy of Brain Edema after Intracerebral Hemorrhage

et al. 2016

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“…Since the hematoma contributes to local mass effect and elevated ICP and elicits pathological cascades that result in biochemical toxicity, it is plausible that early and complete removal of ICH via a minimally invasive method can reduce the secondary injury associated with ICH. 16 Theoretically, this should lead to improved functional outcomes and decreased mortality rates. According to the AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage, no clear evidence at present indicates that ultra-early removal of supratentorial ICH improves functional outcomes or mortality rates.…”

Section: Outcome Improvement With Early and Complete Hematoma Evacuationmentioning

confidence: 99%

Early endoscope-assisted hematoma evacuation in patients with supratentorial intracerebral hemorrhage: case selection, surgical technique, and long-term results

Kuo

Chen²,

et al. 2011

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Object Currently, the effectiveness of minimally invasive evacuation of intracerebral hemorrhage (ICH) utilizing the endoscopic method is uncertain and the technique is considered investigational. The authors analyzed their experience with this method in terms of case selection, surgical technique, and long-term results. Methods The authors performed a retrospective analysis of the clinical and radiographic data obtained in 68 patients treated with endoscope-assisted ICH evacuation. Rebleeding, morbidity, and mortality were recorded as primary end points. Hematoma evacuation rate was calculated by comparing the pre- and postoperative CT scans. Glasgow Coma Scale scores and scores on the extended Glasgow Outcome Scale (GOSE) were recorded at the 6-month postoperative follow-up. The technical aspect of this report explains details of the procedure, the instruments that are used, the methods for hemostasis, and the role of hemostatic agents in the management of intraoperative hemorrhage. The pertinent literature was reviewed and summarized. Results All surgeries were performed within 12 hours of ictus, and 84% of the surgeries were performed within 4 hours. The mortality rate was 5.9%, and surgery-related morbidity occurred in 3 cases (4.4%). The hematoma evacuation rate was 93% overall—96% in the putaminal group, 86% in the thalamic group, and 98% in the subcortical group. The rebleeding rate was 1.5%. The mean operative time was 85 minutes, and the average blood loss was 56 ml. The mean GOSE score was 4.9 at 6-month follow-up. The authors acknowledge the limitations of these preliminary results in a small number of patients. Conclusions The data suggest that early endoscope-assisted ICH evacuation is safe and effective in the management of supratentorial ICH. The rebleeding, morbidity, and mortality rates are low compared with rates reported in the literature for the traditional craniotomy method. This study also showed that early and complete evacuation of ICH may lead to improved outcomes in selected patients. However, the safety and efficacy of endoscope-assisted ICH evacuation should be further investigated in a large, prospective, randomized trial.

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“…As early as 1996, Tomimoto et al (1996) observed upregulated proinflammatory cytokines levels in the brains of patients suffering of acute stroke, while Castillo et al (2002) reported relevance in the plasma TNF-α levels and oedema formation 5 h after the onset of ICH, suggesting that there may be correlation between oedema formation and TNF-α levels. Zuo et al (2009), comparing the clinical outcome of gross total and subtotal removal of deep seated basal ganglia haematomas, used TNF-α levels in cerebrospinal fluid and the amount of haematoma drained for comparison and coloration with final oedema reduction and neurological outcome.…”

Section: Discussionmentioning

confidence: 99%