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 ORIGINAL ARTICLE
Year : 2022  |  Volume : 70  |  Issue : 2  |  Page : 535--542

Comparison of Craniotomy and Stereotactic Aspiration Plus Thrombolysis in Isolated Capsulo-Ganglionic Hematoma: A Retrospective Analyses


1 Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
2 Department of Neurosurgery, Ramkrishna Care Hospital, Raipur, Chhattisgarh, India
3 Department of Anaesthesia and Critical Care, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
4 Department of Critical Care, Ramkrishna Care Hospital, Raipur, Chhattisgarh, India

Correspondence Address:
Dr. Sanjeev Kumar
Department of Neurosurgery, DKS Post Graduate Institute and Research Centre, Raipur, Chhattisgarh - 492 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.344635

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Background: Published trials and meta-analyses have suggested the role of surgery in select patients of hypertensive intracerebral hematoma. Objective: This study compares two methods of hematoma aspiration, craniotomy, and stereotactic aspiration. Methods and Material: We conducted retrospective analyses of patients who underwent surgery for capsule-ganglionic hematoma during Jan-2015–Dec-2019. Surgical, intensive-care parameters, and neurological outcomes were compared. Patients operated for Capsule-Ganglionic hypertensive hematomas, Glasgow Coma Scale (GCS) 5-12, hematoma volume ≥30 ml, no concomitant IVH, age <80 years were included. Results: A total of 173 patients were included (90 craniotomy and 83 stereotactic aspiration groups). Both groups were equivalent in preoperative parameters (P > 0.5). There were no significant differences in residual hematoma volumes, surgical site infections/Meningitis, and chances of re-bleed between the two groups (P > 0.05). The number of days on ventilation, ICU-stay, and hospital-stay were higher in craniotomy group (P < 0.001). Mean Modified Ranking Score (MRS) was lower (P 0.01) in the stereotactic aspiration group. A higher number of patients in the stereotactic aspiration group achieved good MRS (0-2) (P 0.02). Overall case-fatality rate was 38/173 (21.96%) (craniotomy - 24/90 (26.66%), stereotactic aspiration - 14/83 (16.86%), P 0.12). In left-side hematomas, mean MRS was not different between both methods, whereas it differed in the right-side hematomas. On step-wise logistic regression analysis, predicting parameters for the poor outcome (MRS 3-6) were GCS 5-8 (Odds Ratio (OR) 2.38), Left-side (OR 1.75), and craniotomy as a method of evacuation (OR 1.70). Conclusions: Stereotactic aspiration of the hematoma has the superior edge over craniotomy. Neurological and care parameters are significantly better with stereotactic aspiration. Its safety and surgical performance parallel craniotomy.






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