Stereotactic Aspiration For Hypertensive Cerebral Hemorrhage And Analysis

Background and objective The treatment of hypertensive cerebral hemorrhage is controversial. With the development of microscopic surgery and minimally invasive surgery, a trend for improvement with surgery is found. Although the surgical methods for hypertensive cerebral hemorrhage is debating, especially to the patient with moderate hematoma volume on CT scan, it is unclear whether the minimally invasive surgery is beneficial to the patients. It is reported that the stereotactic aspiration for hypertensive cerebral hemorrhage is effective and safe. But there are few report of prospective study on stereotactic aspiration for hypertensive cerebral hemorrhage. This study was conducted prospectively to evaluate the effectiveness of stereotactic aspiration for hypertensive cerebral hemorrhage.Methods At the time of admission,76 patients were diagnosed hypertensive cerebral hemorrhage with hematomas located at basal ganglia. Patients who fit the criteria were prospectively enrolled and randomly assigned to either stereotactic aspiration group and open craniotomy group. Close monitoring, mannitol, haemostatic agents and antibiotics were administrated postoperatively. Dynamic CT scan is utilized to observe the hematoma volume. The events of rebleeding were recorded. The outcomes include postoperative complications,in-hospital mortality rate, neurological outcome and overall mortality at 6 months follow-up.Results The in-hospital mortality and overall mortality are similar in stereotactic aspiration group and open craniotomy group. The comparison of neurological function on admission between these two groups has no significant differences. Two week after the ictus, the neurological assessment of stereotactic aspiration group is better than open craniotomy group(mild neurological deficit rates 64.3%vs.33.3%, p=0.035). There is no significant differences between two groups on rebleeding rate and gastrointestinal bleeding. The incidence of pneumonia in stereotactic aspiration group is significant lower than open craniotomy group(17.9%vs.43.4%,p=0.049).6 months follow-up shows that the ADL degree in stereotactic aspiration group is better than open craniotomy group(gradeâ… +â…¡, 11(39.3%)vs.4(13.3%)).Conclusion According to results of this trial, stereotactic aspiration for hypertensive cerebral hemorrhage is a safe and effective process. Compared with open craniotomy, stereotactic aspiration can reduce the complication rates postoperatively and promote the neurological outcome, but it has no impact to patients'mortality.