The puncture aspiration in surgery of putamenal hemorrhages

Objective. To analyze the efficacy of routine puncture aspiration in surgical treatment of putamenal hemorrhages Material and methods. The retrospective analysis of surgical treatment outcomes at 27 patients with putamenal hemorrhages was conducted. All patients underwent routine aspiration of intracerebral hematoma using universal technique. The operations were conducted under local anesthesia. The mean age of patients was 55 (37-70) years old, 22 were men, women - 5. The mean value of preoperative level of consciousness was 13 (10-15) scores according to GCS. The mean preoperative value of hemiparesis was 1,4 (0-2) scores. The preoperative volume of hematoma was 47 (25-80) ml, the average value of brain shift was 6,1 (3-12) mm. All patients were divided into 3 groups according to time of operation: 1st group (n=6) - operation was performed during first 2 days of disease, 2d group (n=16) - 3-7th days of disease, 3d group (n=5) - 8th day of disease and more. The estimation of treatment outcomes in relation to side of hematoma was conducted as well as the estimation of functional outcome. Results. Lethality was 44% (12 patients died). Lethality was 67% among patients with hematoma in left hemisphere and 17% - at patients with hematoma in right hemisphere. The mean value of hemiparesis at survived patients was 2,1 (0-3) scores at discharge. The mean percentage of evacuated hematoma during operation at patients of various groups was the follow: 1st group - 64% of initial volume of hematoma, 2d group - 53%, 3d group - 77%. The accuracy of reaching the center of hematoma was 74%. The development of severe perifocal edema without hematoma relapse but with repeated development of expressed brain shift was observed at 3 patients in spite of regress of brain shift in early postoperative period and small residual volume of hematoma on 3-4th days after operation. One patient suffered from relapse of hematoma on the 2d day after operation. Conclusion. The routine aspiration was the effective method for removal of putamenal hematoma in conducted study. The usage of such technique allowed achieving the rapid regress of brain shift and partial regress of neurological deficit at majority of patients.

геморрагический инсульт, аспирация, путамен, hemorrhagic stroke, aspiration, putamen

1. Дашьян В.Г., Годков И.М., Кортикова А.Н. Эндоскопическая хирургия внутричерепных гипертензивных кровоизлияний // Нейрохирургия. - 2014. - № 1. - С. 118-125.

2. Дашьян В.Г., Мурашко А. А., Коршикова А.Н., Крылов В.В. Метод видеоэндоскопии в хирургии геморрагического инсульта // Нейрохирургия. - 2012. - № 2. - С. 17-26.

3. Крылов В.В., Буров С.А., Галанкина И.Е., Дашьян В.Г. Локальный фибринолиз в хирургии внутричерепных кровоизлияний // Нейрохирургия. - 2006. - № 3. - С. 4-12.

4. Крылов В.В., Дашьян В.Г., Буров С.А., Петриков С.С. Хирургия геморрагического инсульта. - М.: ОАО «Издательство «Медицина», 2012.

5. Auer L., Deinsberger W., Niederkorn K. et al. Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study // J Neurosurg. - 1989. - Vol.70. - P. 530-535.

6. Bluensuceso A. Predictors of mortality based on CT scan findings of patient admitted due to hypertensive intracerebral hemorrhage at the Philippine heart center // Phil Heart Center J. - 2007. - Vol.13(2). - P. 155-160.

7. Broderick J., Adams H., Barsan W. et al. A Statement for Healthcare Professionals From a Special Writing Group of the Stroke Council, American Heart Association // Stroke. - 1999. - Vol.30. - P. 905-915.

8. Broderick J.P., Brott T.G., Duldner J.E., Tomsick T., Huster G. Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality // Stroke. - 1993. - Vol.24. - P. 987-993.

9. Cho D., Chen C., Lee W., Lee H., Ho L. A new Modified Intracerebral Hemorrhage score for treatment decisions in basal ganglia hemorrhage-- a randomized trial // Crit Care Med. - 2008. - P.36(7). - P. 2151-2156.

10. Hirano H., Yokoyama S., Asakura T. Outcome evaluation in putaminal hemorrhage by multiple regression analysis // No Shinkei Geka. - 1994. - Vol.22(12). - P. 1135-1140.

11. Kaya R., Tokmenoрlu O., Ziyal I. et al. The effects on prognosis of surgical treatment of hypertensive putaminal hematomas through transsylvian transinsular approach // Surgical Neurology. - 2003. - Vol. 59(3). - P. 176-183.

12. Krishnan P., Mohanty N., Sekhar S., Evaluation of Relationship Between Volume of Intracerebral Bleed with Mortality Rate: A Hospital Based Study // International Journal of Research in Pharmaceutical and Biomedical Sciences. - 2013. - Vol.4(1). - P.100-105.

13. Liu C., Chu N., Ryu S. CT, somatosensory and brainstem auditory evoked potentials in the early prediction of functional outcome in putaminal hemorrhage // Acta Neurol Scand. - 1991. - Vol. 84(1). P. 28-32.

14. Mizukami M., Nishijima M., Kin H. Computed tomographic findings of good prognosis for hemiplegia in hypertensive putaminal hemorrhage // Stroke. - 1981. - Vol.12. - P. 648-652.

15. Morgenstern L., Hemphill J., Anderson C. et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association // Stroke. - 2010. - Vol.41.-P 2108-2129.

16. Murthy J., Chowdary G., Murthy T., Bhasha P., Naryanan T. Decompressive craniectomy with clot evacuation in large hemispheric hypertensive intracerebral hemorrhage // Neurocrit Care. - 2005. - Vol.2(3). - P. 258-262.

17. Nag C., Das K., Ghosh M., Khandakar M.R. Prediction of clinical outcome in acute hemorrhagic stroke from a single CT scan on admission // North American Journal of medical sciences. - 2012. - Vol.4(10). - P. 463-467.

18. Nagaratnam et al., Putaminal Hemorrhage and Outcome // Neurorehabil Neural Repair. - 2001. - Vol.15: 1: 51.

19. Ramnarayan R., Anto D., Anilkumar T., Nayar R. Decompressive Hemicraniectomy in Large Putaminal Hematomas: An Indian Experience // Journal of Stroke and Cerebrovascular Diseases. - 2009. - Vol.18(1). - P. 1-10.

20. Takeuchi S., Takasato Y., Masaoka H., et al. Decompressive craniectomy with hematoma evacuation for large hemispheric hypertensive intracerebral hemorrhage. Acta Neurochir Suppl. - 2013. - Vol.118. - P. 277-279.

21. Talacchi A., Ricci U., Caramia G., Massimo G. Basal ganglia haemorrhages: efficacy and limits of different surgical strategies // British Journal of Neurosurgery. - 2011. - Vol. 25(2). - P. 235-242.

22. Shokouhi G., Farhoudi M., Afrough A., Hamdi A. Prediction of spontaneous intracerebral hemorrhages outcome // Research Journal of biological sciences. - 2009. - Vol.4(1). - P. 7-10.

23. Shin D., Yoon S., Kim S., Shim J., Bae H. Open Surgical Evacuation of Spontaneous Putaminal Hematomas: Prognostic Factors and Comparison of Outcomes between Transsylvian and Transcortical Approaches // Journal of Korean Neurosurgical Society. - 2008. - Vol. 44(1). - P. 1-7.

24. Zan X., Li H., Liu W. et al. Endoscopic surgery versus conservative treatment for the moderate-volume hematoma in spontaneous basal ganglia hemorrhage (ECMOH): study protocol for a randomized controlledtrial // BMC Neurol. - 2012. - Vol.7. - P. 12-34.

25. Zhang H., Xue S., Li P.J., Fu Y.B., Xu R.X. Treatment of huge hypertensive putaminal hemorrhage by surgery and cerebrospinal fluid drainage. Clin Neurol Neurosurg // 2013. - Vol.115(9). - P. 1602-8.

26. Zhang Y., Ding W., Yang Y. et al. Effects of transsylvian-transinsular approach to hypertensive putaminal hematoma operation and electroacupuncture on motor recovery // J Craniofac Surg. - 2011. - Vol.22(5). - P. 1626-1630.

27. Zheng J., Li H., Guo R. et al. Minimally invasive surgery treatment for the patients with spontaneous supratentorial intracerebral hemorrhage (MISTICH): protocol of a multi-center randomized controlled trial // BMC Neurol. - 2014. - Vol.10. - P. 206.

28. Wang G., Li S., Huang Y. et al. Can minimally invasive puncture and drainage for hypertensive spontaneous Basal Ganglia intracerebral hemorrhage improve patient outcome: a prospective non-randomized comparative study // Military Medical Research. - Vol.2014. - 1:10.