Even in Patients with a Small Hemorrhagic Volume, Stereotactic-Guided Evacuation of Spontaneous Intracerebral Hemorrhage Improves Functional Outcome

  • Kim, Young-Zoon (Department of Neurosurgery, Sungkyunkwan University School of Medicine, Masan Samsung Hospital) ;
  • Kim, Kyu-Hong (Department of Neurosurgery, Sungkyunkwan University School of Medicine, Masan Samsung Hospital)
  • Published : 2009.08.28


Objective: The decision to adopt a conservative or surgical modality for a relatively small volume of spontaneous intracerebral hemorrhage (SICH) is difficult and often controversial, especially when consciousness is tolerable. The authors examined the results of stereotactic-guided evacuation of SICH for relatively small volumes with respect to functional outcome. Methods: This prospective study was performed on 387 patients with SICH who underwent stereotactic-guided evacuation (n = 204, group A) or conservative treatment (n = 183, group B) during the past 8 years. The primary end-point was recovery of functional status, which was estimated using the Modified Barthel Index (MBI) and the modified Rankin Scale (mRS). Results: All patients had a Glasgow coma scale (GCS) score of $\geq$ 13 and unilateral hemiparesis of less than motor power grade 3. Group demographic characteristics and initial neurological statuses were similar. In all cases, the volume of SICH involved was < 30 cm$^3$ and location was limited to basal ganglia and thalamus. At 6-month follow-ups, MBI was 90.9 in group A and 62.4 in group B (p < 005), and MRS was 1.2 in group A and 3.0 in group B (p < 0.05). Better motor function and stereotactic-guided evacuation had a significant effect on a functional recovery in regression analyses. Conclusion: Even in patients with a small volume of SICH, stereotactic-guided evacuation improved functional recovery in activities in daily life than conservative treatment did.


  1. Ahn CS, Lee SK, Kim HS, Kong MH, Song KY, Kang DS : Surgicaloutcome of spontaneous intracerebral hemorrhage in less than stuporousmental status. J Korean Neurosurg Soc 35 : 290-296, 2004
  2. Anderson CS, Chakera TM, Stewart-Wynne EG, Jamrozik KD :Spectrum of primary intracerebral haemorrhage in Perth, WesternAustralia, 1989-90 : incidence and outcome. J Neurol NeurosurgPsychiatry 57 : 936-940, 1994
  3. Auer LM, Deinsberger W, Niederkorn K, Gell G, Kleinert R, Schneider G, et al. : Endoscopic surgery versus medical treatment forspontaneous intracerebral hematoma : a randomized study. J Neurosurg70 : 530-535, 1989
  4. Batjer HH, Reisch JS, Allen BC, Plaizier LJ, Su CJ : Failure of surgeryto improve outcome in hypertensive putaminal hemorrhage. A prospectiverandomized trial. Arch Neurol 47 : 1103-1106, 1990
  5. Bonita R, Beaglehole R : Recovery of motor function after stroke.Stroke 19 : 1497-1500, 1988
  6. Broderick JP, Adams HP Jr, Barsan W, Feinberg W, Feldmann E,Grotta J, et al. : Guidelines for the management of spontaneousintracerebral hemorrhage : a statement for healthcare professionalfrom a special writing group of the Stroke council. American HeartAssociation. Stroke 30 : 905-915, 1999
  7. Broderick JP, Brott T, Tomsick T, Miller R, Huster G : Intracerebralhemorrhage more than twice as common as subarachnoid hemorrhage.J Neurosurg 78 : 188-191, 1993
  8. Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G : Volumeof intracerebral hemorrhage. A powerful and easy-to-use predictor of30-day mortality. Stroke 24 : 987-993, 1993
  9. Carr JH, Shepherd RB, Nordholm L, Lynne D : Investigation of anew motor assessment scale for stroke patients. Phys Ther 65 : 175-180, 1985
  10. Cho DY, Chen CC, Lee HC, Lee WY, Lin HL : Glasgow Coma Scaleand hematoma volume as criteria for treatment of putaminal andthalamic intracerebral hemorrhage. Surg Neurol 70 : 628-633, 2008
  11. Cho TG, Nam DH, Cho BM, Lee JI, Kim JS, Hong SC, et al. :Stereotactic evacuation of spontaneous intracerebral hemorrhage. JKorean Neurosurg Soc 28 : 237-245, 1999
  12. Counsell C, Boonyakarnkul S, Dennis M, Sandercock P, Bamford J,Burn J, et al. : Primary intracerebral haemorrhage in the OxfordshireCommunity Stroke Project, 2 : prognosis. Cerebrovasc Dis 5 : 26-34,1995
  13. Doi E, Moriwaki H, Komai N, Iwamoto M : [Stereotactic evacuationof intracerebral hematomas.] Neurol Med Chir (Tokyo) 22 : 461-467, 1982
  14. Evers SM, Ament AJ, Blaauw G : Economic evaluation in strokeresearch : a systematic review. Stroke 31 : 1046-1053, 2000
  15. Gedders JML, Chamberlain MA, Bonasall M : The leeds familyplacement scheme : principles, participants and postscript. ClinRehabi 5 : 53-64, 1991
  16. Gladman JRF, Lincoln NB, Barer DH : A randomized controlled trialof domiciliary and hospital-based rehabilitation for stroke patientsafter discharge from hospital. J Neurosurg Psychiatry 56 : 960-966,1993
  17. Gladman J, Whynes D, Lincoln N : Cost comparison of domiciliaryand hospital-based stroke rehabilitation. DOMINO study group.Age Ageing 23 : 241-245, 1994
  18. Hattori N, Katayama Y, Maya Y, Gatherer A : Impact of stereotactichematoma evacuation on activities of daily living during the chronicperiod following spontaneous putaminal hemorrhage : a randomizedstudy. J Neurosurg 101 : 417-420, 2004
  19. Lee JC, Min BK, Park K, Suk JS : The clinical analysis of stereotacticaspiration of spontaneous intracerebral hemorrhage. J KoreanNeurosurg Soc 26 : 347-353, 1997
  20. Mahoney FI, Barthel DW : Functional evaluation : the Barthel Index.Md State Med J 14 : 61-65, 1965
  21. Matsumoto K, Hondo H : [Surgical indication for hypertensive brainhemorrhage - update.] No To Shinke 46 : 105-117, 1994
  22. Medical Research Council : Aids to the examination of the peripheralnervous system. London : Her Majesty’s Stationary Office, 1976
  23. Teasdal G, Jennet B : Assessment of coma and impaired consciousnessA practical scale. Lancet 2 : 81-84, 1974