W Deinsberger1, C Lang, C Hornig, D K Boeker. 1. Neurosurgical Clinic, Justus Liebig University, Giessen, Germany. wolfgang.deinsberger@neuro.med.uni-giessen.de
Abstract
OBJECTIVES: Since introduction of stereotactic aspiration and fibrinolysis into the treatment of deep-seated intracerebral hematomas by Hondo and Matsumoto 1984 this method has become widely used, and satisfactory morphological results are achieved. Nevertheless, whether the outcome is improved has not yet been investigated. MATERIAL AND METHOD: 17 patients with spontaneous intracerebral hematomas have been treated surgically; after angiographic exclusion of avascular malformation stereotactic aspiration and fibrinolysis with 3 mg rTPA was performed. Between 1992 and 1995 104 patients were treated conservatively according to best medical treatment. From this group "matched pairs" with the surgical patients were set up concurring in primary (consciousness, size and location of the hematoma) and secondary parameters (age, sex, ventricular hemorrhage). Endpoint of the study was the Glasgow outcome score (GOS) six months after treatment. Data were analyzed statistically and p < 0.05 was considered significant. RESULTS: In respect of primary parameters complete concurrence and regarding secondary parameters far-reaching concurrence was achieved. In no parameter the surgical and conservative group were significantly different from each other. Six months after the ictus no significant difference between surgical and conservative treatment concerning GOS could be established. CONCLUSION: These results indicate that patients do not benefit from stereotactic aspiration and fibrinolysis of putamenal hematomas. For a final treatment recommendation a prospective randomised trial is required.
RCT Entities:
OBJECTIVES: Since introduction of stereotactic aspiration and fibrinolysis into the treatment of deep-seated intracerebral hematomas by Hondo and Matsumoto 1984 this method has become widely used, and satisfactory morphological results are achieved. Nevertheless, whether the outcome is improved has not yet been investigated. MATERIAL AND METHOD: 17 patients with spontaneous intracerebral hematomas have been treated surgically; after angiographic exclusion of a vascular malformation stereotactic aspiration and fibrinolysis with 3 mg rTPA was performed. Between 1992 and 1995 104 patients were treated conservatively according to best medical treatment. From this group "matched pairs" with the surgical patients were set up concurring in primary (consciousness, size and location of the hematoma) and secondary parameters (age, sex, ventricular hemorrhage). Endpoint of the study was the Glasgow outcome score (GOS) six months after treatment. Data were analyzed statistically and p < 0.05 was considered significant. RESULTS: In respect of primary parameters complete concurrence and regarding secondary parameters far-reaching concurrence was achieved. In no parameter the surgical and conservative group were significantly different from each other. Six months after the ictus no significant difference between surgical and conservative treatment concerning GOS could be established. CONCLUSION: These results indicate that patients do not benefit from stereotactic aspiration and fibrinolysis of putamenal hematomas. For a final treatment recommendation a prospective randomised trial is required.
Authors: Ryan J Barrett; Rahat Hussain; William M Coplin; Samera Berry; Penelope M Keyl; Daniel F Hanley; Robert R Johnson; J Ricardo Carhuapoma Journal: Neurocrit Care Date: 2005 Impact factor: 3.210
Authors: J Ricardo Carhuapoma; Ryan J Barrett; Penelope M Keyl; Daniel F Hanley; Robert R Johnson Journal: Neurocrit Care Date: 2008 Impact factor: 3.210