Surgical management for large hypertensive basal ganglionic hemorrhage: single center experience

Purpose We aim to summarize the role of surgical treatment of spontaneous basal ganglionic hemorrhage based on prospective analysis of our patients and determine the factors that favor the outcome. Methods A prospective analysis was done of 66 patients from January 2014 to June 2017. Inclusion criteria for the patients in this study were as follows: patients aged between 15 and 60 years; CT scan showed basal ganglionic hematoma with or without intraventricular extension within 24 h post ictus; hematoma volume was Glasgow Coma Scale (GCS) scores >= 5, and stable vital signs. Surgical techniques are open craniotomy. Results A total of 66 patients underwent surgical intervention consisting of 47 (71.2%) men and 19 (28.8%) women. Their age varies from 15 to 60 with mean age +/- SD (range) 46.53 +/- 13.24 (18.0-60.0). According to GCS, patients were categorized into three groups: GCS 5-8, 21 (31.8%) patients; GCS 9-12, 30 (45.5%) patients; and GCS 13-15, 15 (22.7%) patients. The favorable outcome group was slightly younger (p value 0.050*). Also, the volume and extension of hematoma into the ventricular system, hydrocephalic dilatation, and midline shift greater than 5 mm had a significantly worse outcome with statistically significant difference. Conclusion The early surgical management with removal of the hematoma led to dramatic reduction of ICP and improved the prognosis. Patients with signs of brain herniation, a midline shift > 5 mm, hydrocephalic dilatation, ventricular hemorrhage, and a depressed level of consciousness have a poor prognosis.