Impact of stereotactic hematoma evacuation on activities of daily living during the chronic period following spontaneous putaminal hemorrhage: a randomized study

Naoyuki Hattori M.D.1, Yoichi Katayama M.D., Ph.D.1, Yoshio Maya Ph.D.1, and Alexander Gatherer M.D.1
View More View Less
  • 1 Department of Neurological Surgery, Nihon University School of Medicine, Tokyo; Department of Social Insurance, Nihon University School of Commerce, Tokyo, Japan; and Medical Risk Management Center, Wolfson College, University of Oxford, United Kingdom
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $515.00
USD  $612.00
Print or Print + Online Sign in

Object. Stereotactic evacuation of hematoma has been reported to reduce the incidence of mortality and to improve functional outcome in patients with spontaneous putaminal hemorrhage. Stereotactic evacuation of hematoma has not been widely accepted as a standard therapy, however, because its effect on functional outcome has been regarded as marginal and there have been no randomized trials with sufficient statistical power to quantify the benefits of this procedure. The authors reassessed the value of stereotactic evacuation of hematoma by analyzing its impact on activities of living during the chronic period following spontaneous putaminal hemorrhage in a randomized study.

Methods. Four hundred ninety patients were entered into the study. The severity of their hemorrhages was graded neurologically on admission (neurological grades: 1, eyes are open; 2, eyes are closed but open to weak stimuli; 3, eyes are closed but open to strong stimuli; 4, eyes do not open but extremities move to stimuli; and 5, eyes do not open and extremities do not move to stimuli). Patients with Grade 2 and those with Grade 3 were randomized into two groups with different treatment protocols (Group I, stereotactic evacuation of the hematoma; and Group II, conservative treatment). Patients assigned neurological Grade 4 or 5 were excluded from the study because a large-scale retrospective study in Japan revealed that surgical treatment in patients assigned to these neurological grades does not improve functional outcome. Among the 490 patients, 242 were randomized strictly. This patient population comprised 148 men and 94 women ranging in age from 38 to 80 years (mean 60.5 years).

Compared with Group II, Group I treatment resulted in a lower mortality rate and better recovery to functional independence in patients with neurological Grade 3. In patients with Grade 2, Group I treatment contributed to a better recovery of functional outcome and a lower mortality rate, but the difference was not significant. Multivariate analysis confirmed that stereotactic evacuation of the hematoma was contributory to a better recovery in functional outcome.

Conclusions. Stereotactic evacuation of hematoma is clearly of value in selected patients with spontaneous putuminal hemorrhage, whose eyes are closed but will open in response to strong stimuli (neurological Grade 3) on admission.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $515.00
USD  $612.00
  • 1.

    Auer LM, , Deinsberger W, & Niederkorn K, et al: Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. J Neurosurg 70:530535, 1989 Auer LM, Deinsberger W, Niederkorn K, et al: Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. J Neurosurg 70:530–535, 1989

    • Search Google Scholar
    • Export Citation
  • 2.

    Bamford J, , Sandercock PA, & Warlow CP, et al: Interobserver agreement for the assessment of handicap in stroke patients. Stroke 20:828, 1989 (Letter) Bamford J, Sandercock PA, Warlow CP, et al: Interobserver agreement for the assessment of handicap in stroke patients. Stroke 20:828, 1989 (Letter)

    • Search Google Scholar
    • Export Citation
  • 3.

    Batjer HH, , Reisch JS, & Allen BC, et al: Failure of surgery to improve outcome in hypertensive putaminal hemorrhage. A prospective randomized trial. Arch Neurol 47:11031106, 1990 Batjer HH, Reisch JS, Allen BC, et al: Failure of surgery to improve outcome in hypertensive putaminal hemorrhage. A prospective randomized trial. Arch Neurol 47:1103–1106, 1990

    • Search Google Scholar
    • Export Citation
  • 4.

    Broderick JP, , Adams HP Jr, & Barsan W, et al: Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. A statement for healthcare professionals from a special writing group of the stroke council, American Heart Association. Stroke 30:905915, 1999 Broderick JP, Adams HP Jr, Barsan W, et al: Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. A statement for healthcare professionals from a special writing group of the stroke council, American Heart Association. Stroke 30:905–915, 1999

    • Search Google Scholar
    • Export Citation
  • 5.

    Broderick JP, , Brott TG, & Duldner JE, et al: Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke 24:987993, 1993 Broderick JP, Brott TG, Duldner JE, et al: Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke 24:987–993, 1993

    • Search Google Scholar
    • Export Citation
  • 6.

    Broseta J, , Gonzalez-Darder J, & Barcia-Salorio JL: Stereotactic evacuation of intracerebral hematomas. Appl Neurophysiol 45:443448, 1982 Broseta J, Gonzalez-Darder J, Barcia-Salorio JL: Stereotactic evacuation of intracerebral hematomas. Appl Neurophysiol 45:443–448, 1982

    • Search Google Scholar
    • Export Citation
  • 7.

    Doi E, , Moriwaki H, & Komai N, et al: [Stereotactic evacuation of intracerebral hematomas.] Neurol Med Chir 22:461467, 1982 (Jpn) Doi E, Moriwaki H, Komai N, et al: [Stereotactic evacuation of intracerebral hematomas.] Neurol Med Chir 22:461–467, 1982 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 8.

    Evers SMAA, , Ament AJHA, & Blaauw G: Economic evaluation in stroke research: a systematic review. Stroke 31:10461053, 2000 Evers SMAA, Ament AJHA, Blaauw G: Economic evaluation in stroke research: a systematic review. Stroke 31:1046–1053, 2000

    • Search Google Scholar
    • Export Citation
  • 9.

    Geddes JML, , Chamberlain MA, & Bonsall M: The Leeds Family Placement Scheme: principles, participants and postscript. Clin Rehabil 5:5364, 1991 Geddes JML, Chamberlain MA, Bonsall M: The Leeds Family Placement Scheme: principles, participants and postscript. Clin Rehabil 5:53–64, 1991

    • Search Google Scholar
    • Export Citation
  • 10.

    Geddes JML, , Claiden AD, & Chamberlain MA, et al: The Leeds Family Placement Scheme: an evaluation of its use as a rehabilitation resource. Clin Rehabil 3:189197, 1989 Geddes JML, Claiden AD, Chamberlain MA, et al: The Leeds Family Placement Scheme: an evaluation of its use as a rehabilitation resource. Clin Rehabil 3:189–197, 1989

    • Search Google Scholar
    • Export Citation
  • 11.

    Gladman J, , Whynes D, & Lincoln N: Cost comparison of domiciliary and hospital-based stroke rehabilitation. DOMINO study group. Age Ageing 23:241245, 1994 Gladman J, Whynes D, Lincoln N: Cost comparison of domiciliary and hospital-based stroke rehabilitation. DOMINO study group. Age Ageing 23:241–245, 1994

    • Search Google Scholar
    • Export Citation
  • 12.

    Gladman JRF, , Lincoln NB, & Barer DH: A randomised controlled trial of domiciliary and hospital-based rehabilitation for stroke patients after discharge from hospital. J Neurol Neurosurg Psychiatry 56:960966, 1993 Gladman JRF, Lincoln NB, Barer DH: A randomised controlled trial of domiciliary and hospital-based rehabilitation for stroke patients after discharge from hospital. J Neurol Neurosurg Psychiatry 56:960–966, 1993

    • Search Google Scholar
    • Export Citation
  • 13.

    Hankey GJ, & Hon C: Surgery for primary intracerebral hemorrhage: is it safe and effective? A systematic review of case series and randomized trials. Stroke 28:21262132, 1997 Hankey GJ, Hon C: Surgery for primary intracerebral hemorrhage: is it safe and effective? A systematic review of case series and randomized trials. Stroke 28:2126–2132, 1997

    • Search Google Scholar
    • Export Citation
  • 14.

    Higgins AC, & Nashold BS Jr: Stereotactic evacuation of large intracerebral hematoma. Appl Neurophysiol 43:96103, 1980 Higgins AC, Nashold BS Jr: Stereotactic evacuation of large intracerebral hematoma. Appl Neurophysiol 43:96–103, 1980

    • Search Google Scholar
    • Export Citation
  • 15.

    Holloway RG, , Benesch CG, & Rahilly CR, et al: A systematic review of cost-effectiveness research of stroke evaluation and treatment. Stroke 30:13401349, 1999 Holloway RG, Benesch CG, Rahilly CR, et al: A systematic review of cost-effectiveness research of stroke evaluation and treatment. Stroke 30:1340–1349, 1999

    • Search Google Scholar
    • Export Citation
  • 16.

    Hondo H, & Matsumoto K: [CT-guided stereotactic evacuation of hypertensive and traumatic intracerebral hemorrhage—experiences with 35 cases.] No Shinkei Geka 11:3548, 1983 (Jpn) Hondo H, Matsumoto K: [CT-guided stereotactic evacuation of hypertensive and traumatic intracerebral hemorrhage—experiences with 35 cases.] No Shinkei Geka 11:35–48, 1983 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 17.

    Juvela S, , Heiskanen O, & Poranen A, et al: The treatment of spontaneous intracerebral hemorrhage. A prospective randomized trial of surgical and conservative treatment. J Neurosurg 70:755758, 1989 Juvela S, Heiskanen O, Poranen A, et al: The treatment of spontaneous intracerebral hemorrhage. A prospective randomized trial of surgical and conservative treatment. J Neurosurg 70:755–758, 1989

    • Search Google Scholar
    • Export Citation
  • 18.

    Kanaya H, & Kuroda K: Development in neurosurgical approaches to hypertensive intracerebral hemorrhage, in Kaufman HH (ed): Intracerebral Hematomas. New York: Raven Press, 1992, pp 197210 Kanaya H, Kuroda K: Development in neurosurgical approaches to hypertensive intracerebral hemorrhage, in Kaufman HH (ed): Intracerebral Hematomas. New York: Raven Press, 1992, pp 197–210

    • Search Google Scholar
    • Export Citation
  • 19.

    Kanaya H, , Yukawa H, & Ito Z, et al: Grading and indications for treatment of ICH of basal ganglia (cooperative study in Japan), in Pia HW, , Langmaid C, & Zierski J (eds): Spontaneous Intracerebral Hematomas: Advances in Diagnosis and Therapy. Berlin: Springer-Verlag, 1980, pp 268274 Kanaya H, Yukawa H, Ito Z, et al: Grading and indications for treatment of ICH of basal ganglia (cooperative study in Japan), in Pia HW, Langmaid C, Zierski J (eds): Spontaneous Intracerebral Hematomas: Advances in Diagnosis and Therapy. Berlin: Springer-Verlag, 1980, pp 268–274

    • Search Google Scholar
    • Export Citation
  • 20.

    Kandel EI, & Peresedov VV: Stereotactic evacuation of spontaneous intracerebral hematomas. J Neurosurg 62:206213, 1985 Kandel EI, Peresedov VV: Stereotactic evacuation of spontaneous intracerebral hematomas. J Neurosurg 62:206–213, 1985

    • Search Google Scholar
    • Export Citation
  • 21.

    Matsumoto K, & Hondo H: [Surgical indication for hypertensive brain hemorrhage—update]. No To Shinkei 46:105117, 1994 (Jpn) Matsumoto K, Hondo H: [Surgical indication for hypertensive brain hemorrhage—update]. No To Shinkei 46:105–117, 1994 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 22.

    McKissock W, , Richardson A, & Taylor J: Primary intracerebral hemorrhage. A controlled trial of surgical and conservative treatment in 180 unselected cases. Lancet 2:221226, 1961 McKissock W, Richardson A, Taylor J: Primary intracerebral hemorrhage. A controlled trial of surgical and conservative treatment in 180 unselected cases. Lancet 2:221–226, 1961

    • Search Google Scholar
    • Export Citation
  • 23.

    Medical Research Council: Aids to the Examination of the Peripheral Nervous System. London: Her Majesty's Stationery Office, 1976 Medical Research Council: Aids to the Examination of the Peripheral Nervous System. London: Her Majesty's Stationery Office, 1976

    • Search Google Scholar
    • Export Citation
  • 24.

    Morgenstern LB, , Frankowski RF, & Shedden P, et al: Surgical treatment for intracerebral hemorrhage (STICH): a single-center, randomized clinical trial. Neurology 51:13591363, 1998 Morgenstern LB, Frankowski RF, Shedden P, et al: Surgical treatment for intracerebral hemorrhage (STICH): a single-center, randomized clinical trial. Neurology 51:1359–1363, 1998

    • Search Google Scholar
    • Export Citation
  • 25.

    Niizuma H, , Shimizu Y, & Yonemitsu T, et al: Results of stereotactic aspiration in 175 cases of putaminal hemorrhage. Neurosurgery 24:814819, 1989 Niizuma H, Shimizu Y, Yonemitsu T, et al: Results of stereotactic aspiration in 175 cases of putaminal hemorrhage. Neurosurgery 24:814–819, 1989

    • Search Google Scholar
    • Export Citation
  • 26.

    Okimura Y, , Ono J, & Iwadate Y, et al: [Evaluation of CT-guided stereotactic hematoma aspiration in mild cases with putaminal hemorrhage.] No Shinkei Geka 19:611617, 1991 (Jpn) Okimura Y, Ono J, Iwadate Y, et al: [Evaluation of CT-guided stereotactic hematoma aspiration in mild cases with putaminal hemorrhage.] No Shinkei Geka 19:611–617, 1991 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 27.

    Portenoy RK, , Lipton RB, & Berger AR, et al: Intracerebral hemorrhage: a model for the prediction of outcome. J Neurol Neurosurg Psychiatry 50:976979, 1987 Portenoy RK, Lipton RB, Berger AR, et al: Intracerebral hemorrhage: a model for the prediction of outcome. J Neurol Neurosurg Psychiatry 50:976–979, 1987

    • Search Google Scholar
    • Export Citation
  • 28.

    Prasad K, , Browman G, & Srivastava A, et al: Surgery in primary supratentorial intracerebral hematoma: a meta-analysis of randomized trials. Acta Neurol Scand 95:103110, 1997 Prasad K, Browman G, Srivastava A, et al: Surgery in primary supratentorial intracerebral hematoma: a meta-analysis of randomized trials. Acta Neurol Scand 95:103–110, 1997

    • Search Google Scholar
    • Export Citation
  • 29.

    Rankin J: Cerebral vascular accidents in patients over the age of 60: II. Prognosis. Scott Med J 2:200215, 1957 Rankin J: Cerebral vascular accidents in patients over the age of 60: II. Prognosis. Scott Med J 2:200–215, 1957

    • Search Google Scholar
    • Export Citation
  • 30.

    Sadoshima S, , Sugimori H, & Irie K, et al: [Functional outcome at 3.2 years after stroke attack in Fukuoka Prefecture.] Japan J Stroke 17:153159, 1995 (Jpn) Sadoshima S, Sugimori H, Irie K, et al: [Functional outcome at 3.2 years after stroke attack in Fukuoka Prefecture.] Japan J Stroke 17:153–159, 1995 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 31.

    Takahashi K, , Kuroda K, & Kanaya H: [Prediction of outcome in putaminal hemorrhage.] No To Shinkei 45:711718, 1993 (Jpn) Takahashi K, Kuroda K, Kanaya H: [Prediction of outcome in putaminal hemorrhage.] No To Shinkei 45:711–718, 1993 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 32.

    Takahashi K, , Kuroda K, & Kanaya H: Prediction of putaminal hemorrhage mortality by logistic regression analysis. Ann Rept Iwate Med Univ Sch Lib Arts & Sci 26:115124, 1991 Takahashi K, Kuroda K, Kanaya H: Prediction of putaminal hemorrhage mortality by logistic regression analysis. Ann Rept Iwate Med Univ Sch Lib Arts & Sci 26:115–124, 1991

    • Search Google Scholar
    • Export Citation
  • 33.

    Tan SH, , Ng PY, & Yeo TT, et al: Hypertensive basal ganglia hemorrhage: a prospective study comparing surgical and nonsurgical management. Surg Neurol 56:287293, 2001 Tan SH, Ng PY, Yeo TT, et al: Hypertensive basal ganglia hemorrhage: a prospective study comparing surgical and nonsurgical management. Surg Neurol 56:287–293, 2001

    • Search Google Scholar
    • Export Citation
  • 34.

    Tanahashi N, & Fukuuchi Y, Keio Cooperative Stroke Study Group: [Current status of treatment for hypertensive intracerebral hemorrhage—Keio Cooperative Stroke Study—.] Japan J Stroke 18:483487, 1996 (Jpn) Tanahashi N, Fukuuchi Y, Keio Cooperative Stroke Study Group: [Current status of treatment for hypertensive intracerebral hemorrhage—Keio Cooperative Stroke Study—.] Japan J Stroke 18:483–487, 1996 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 35.

    Tuhrim S, , Dambrosia JM, & Price TR, et al: Prediction of intracerebral hemorrhage survival. Ann Neurol 24:258263, 1988 Tuhrim S, Dambrosia JM, Price TR, et al: Prediction of intracerebral hemorrhage survival. Ann Neurol 24:258–263, 1988

    • Search Google Scholar
    • Export Citation
  • 36.

    van Swieten JC, , Koudstaal PJ, & Visser MC, et al: Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604607, 1988 van Swieten JC, Koudstaal PJ, Visser MC, et al: Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607, 1988

    • Search Google Scholar
    • Export Citation
  • 37.

    Waga S, & Yamamoto Y: Hypertensive putaminal hemorrhage: treatment and results. Is surgical treatment superior to conservative one? Stroke 14:480485, 1983 Waga S, Yamamoto Y: Hypertensive putaminal hemorrhage: treatment and results. Is surgical treatment superior to conservative one? Stroke 14:480–485, 1983

    • Search Google Scholar
    • Export Citation
  • 38.

    Yamanaka R, & Satoh S: Cerebral blood flow in patients with putaminal hemorrhage after stereotactic aspiration or conservative treatment. Neurol Med Chir 29:1519, 1989 Yamanaka R, Satoh S: Cerebral blood flow in patients with putaminal hemorrhage after stereotactic aspiration or conservative treatment. Neurol Med Chir 29:15–19, 1989

    • Search Google Scholar
    • Export Citation
  • 39.

    Young J, & Forster A: Day hospital and home physiotherapy for stroke patients: a comparative cost-effectiveness study. J R Coll Physicians Lond 27:252258, 1993 Young J, Forster A: Day hospital and home physiotherapy for stroke patients: a comparative cost-effectiveness study. J R Coll Physicians Lond 27:252–258, 1993

    • Search Google Scholar
    • Export Citation
  • 40.

    Young WB, , Lee KP, & Pessin MS, et al: Prognostic significance of ventricular blood in supratentorial hemorrhage: a volumetric study. Neurology 40:616619, 1990 Young WB, Lee KP, Pessin MS, et al: Prognostic significance of ventricular blood in supratentorial hemorrhage: a volumetric study. Neurology 40:616–619, 1990

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 830 174 5
Full Text Views 321 14 0
PDF Downloads 200 15 0
EPUB Downloads 0 0 0