Safety and Efficacy of CT-Guided Stereotactic Aspiration in Treatment of Thalamic and Intraventricular Hemorrhage
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- Category: Vol. 80, March 2012
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Safety and Efficacy of CT-Guided Stereotactic Aspiration in Treatment of Thalamic and Intraventricular Hemorrhage,SALEM FAISAL
Abstract
Introduction: At present, there is no consensus on the proper role of surgery in the management of thalamic hemor-rhage. Advances in neuroimaging techniques and improvements in stereotactic instrumentations have led to the increasing use of stereotactic surgery in the neurosurgical field. Our primary aim was to assess the feasibility and safety of stereotactic aspiration in treatment of thalamic and intraventricular hem-orrhage.
Material and Methods: This is a prospective randomized clinical trial in 36 patients with spontaneous thalamic and intraventricular hemorrhage, 16 of them were treated by stereotactic aspiration with external ventricular drainage and the other 20 patients treated by only external ventricular drainage. Patients were followed-up for 3 months post-operatively with physical examinations and diagnostic imaging.
Results: patients treated by stereotactic aspiration and external ventricular drainage had a lower mortality rate 12.5%, less complications (3 cases) and were less likely to require long-term ventricular drainage (3.2±1.1) compared with those undergoing only EVD where the mortality rate was 25%, complications were detected in 6 cases and ventricular drainage period was 7.6±1.9.
9 out of 16 (56.2%) patients treated by stereotactic aspi-ration and EVD had achieved a good recovery (Glasgow outcome scale [GOS] score of 5), 3 patients (18.7%) were dependent (GOS 3), and 2 (12.5%) remained vegetative (GOS). In patients treated with EVD only, 5 patients out of 20 (25%) showed a good recovery, 4 patients (20%) were dependent while 6 patients (30%) remained vegetative. Outcome signif-icantly correlated with initial consciousness level, preoperative volume of hematoma and age.
Conclusion: Stereotactic aspiration of thalamic and intra-ventricular hematoma is a simple, safe and effective method that causes fewer complcations.