Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Stereotactic Hematoma Removal of Spontaneous Intracerebral Hemorrhage through Parietal Approach

  • Kim, Jeong Hoon (Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Cho, Tack Geun (Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Moon, Jae Gon (Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Kim, Chang Hyun (Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Lee, Ho Kook (Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine)
  • Received : 2015.06.30
  • Accepted : 2015.09.15
  • Published : 2015.10.28
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Abstract

Objective : To determine the advantages of parietal approach compared to Kocher's point approach for spontaneous, oval-shaped intracerebral hemorrhage (ICH) with expansion to the parietal region. Methods : We divided patients into two groups : group A had burr holes in the parietal bone and group B had burr holes at Kocher's point. The hematoma volume, Glasgow coma scale (GCS) score, and modified Barthel Index (mBI) score were calculated. At discharge, we evaluated the patients' Glasgow outcome scale (GOS) score, modified Rankin Scale (mRS) score, motor grade, and hospitalization duration. We evaluated the patients' mBI scores and motor grades at 6 months after surgery. Results : The hematoma volume in group A was significantly less than that in group B on postoperative days 1, 3, 5, 7, 14, and 21. Group A had significantly higher GCS scores than did group B on postoperative days 1 and 3. Group A had higher mBI scores postoperatively than did group B, but the scores were not significantly different. No differences were observed for the GOS score, mRS score, motor grade at discharge, or duration of hospitalization. The mBI score of group A at 6 months after surgery was significantly higher, and more patients in group A showed muscle strength improvement. Conclusion : In oval-shaped ICH with expansion to the parietal region, the parietal approach is considered to improve the clinical symptoms at the acute phase by removing the hematoma more effectively in the early stages. The parietal approach might help promote the long-term recovery of motor power.

Keywords

References

  1. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C : A prospective study of acute cerebrovascular disease in the community : the Oxfordshire Community Stroke Project--1981-86. 2. Incidence, case fatality rates and overall outcome at one year of cerebral infarction, primary intracerebral and subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 53 : 16-22, 1990 https://doi.org/10.1136/jnnp.53.1.16
  2. Broderick JP, Brott T, Tomsick T, Miller R, Huster G : Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage. J Neurosurg 78 : 188-191, 1993 https://doi.org/10.3171/jns.1993.78.2.0188
  3. Castellanos M, Leira R, Tejada J, Gil-Peralta A, Davalos A, Castillo J; Stroke Project, Cerebrovascular Diseases Group of the Spanish Neurological Society : Predictors of good outcome in medium to large spontaneous supratentorial intracerebral haemorrhages. J Neurol Neurosurg Psychiatry 76 : 691-695, 2005 https://doi.org/10.1136/jnnp.2004.044347
  4. Cho SH, Kim SH, Choi BY, Cho SH, Kang JH, Lee CH, et al. : Motor outcome according to diffusion tensor tractography findings in the early stage of intracerebral hemorrhage. Neurosci Lett 421 : 142-146, 2007 https://doi.org/10.1016/j.neulet.2007.04.052
  5. Cho TG, Nam DH, Cho BM, Lee JI, Kim JS, Hong SC, et al. : Stereotactic evacuation of spontaneous intracerebral hemorrhage. J Korean Neurosurg Soc 28 : 237-245, 1999
  6. Delgado P, Alvarez-Sabin J, Abilleira S, Santamarina E, Purroy F, Arenillas JF, et al. : Plasma d-dimer predicts poor outcome after acute intrace rebral hemorrhage. Neurology 67 : 94-98, 2006 https://doi.org/10.1212/01.wnl.0000223349.97278.e0
  7. Duffau H : Intraoperative direct subcortical stimulation for identification of the internal capsule, combined with an image-guided stereotactic system during surgery for basal ganglia lesions. Surg Neurol 53 : 250-254, 2000 https://doi.org/10.1016/S0090-3019(00)00183-X
  8. Fewel ME, Thompson BG Jr, Hoff JT : Spontaneous intracerebral hemorrhage : a review. Neurosurg Focus 15 : E1, 2003
  9. Jang SH : A review of corticospinal tract location at corona radiata and posterior limb of the internal capsule in human brain. NeuroRehabilitation 24 : 279-283, 2009
  10. Jang SH : The recovery of walking in stroke patients : a review. Int J Rehabil Res 33 : 285-289, 2010 https://doi.org/10.1097/MRR.0b013e32833f0500
  11. Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, et al. : The ABCs of measuring intracerebral hemorrhage volumes. Stroke 27 : 1304-1305, 1996 https://doi.org/10.1161/01.STR.27.8.1304
  12. Kuo LT, Chen CM, Li CH, Tsai JC, Chiu HC, Liu LC, et al. : Early endoscope-assisted hematoma evacuation in patients with supratentorial intracerebral hemorrhage : case selection, surgical technique, and longterm results. Neurosurg Focus 30 : E9, 2011
  13. Kwon H, Jang SH : Delayed recovery of gait function in a patient with intracerebral haemorrhage. J Rehabil Med 44 : 378-380, 2012 https://doi.org/10.2340/16501977-0962
  14. Pantazis G, Tsitsopoulos P, Mihas C, Katsiva V, Stavrianos V, Zymaris S : Early surgical treatment vs conservative management for spontaneous supratentorial intracerebral hematomas : a prospective randomized study. Surg Neurol 66 : 492-501; discussion 501-502, 2006 https://doi.org/10.1016/j.surneu.2006.05.054
  15. Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF : Spontaneous intracerebral hemorrhage. N Engl J Med 344 : 1450-1460, 2001 https://doi.org/10.1056/NEJM200105103441907
  16. Qureshi AI, Wilson DA, Hanley DF, Traystman RJ : Pharmacologic reduction of mean arterial pressure does not adversely affect regional cerebral blood flow and intracranial pressure in experimental intracerebral hemorrhage. Crit Care Med 27 : 965-971, 1999 https://doi.org/10.1097/00003246-199905000-00036
  17. Tanizaki Y : Improvement of cerebral blood flow following stereotactic surgery in patients with putaminal haemorrhage. Acta Neurochir (Wien) 90 : 103-110, 1988 https://doi.org/10.1007/BF01560562

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