Benefits of adapting minimal invasive techniques to selected patients with spontaneous supratentorial intracerebral hematomas

Objectives: This study assesses the benefits of adapting minimal invasive techniques (MIT) to selected patients with spontaneous supratentorial intracerebral hematomas (SSICHs). Methods: The study compares the post-operative residual clot volume and clinical outcome of 89 selected, MIT evacuated SSICH-patients to those of 738 unselected cases operated in our department. Selection criteria includes patient age, early admission and MIT treatment. MIT treatment included. 28 patients with deep SSICHs smaller than 30 cm(3) associated with intraventricular bleeding who underwent neuronavigation-guided stereotactic catheter lysis, 37 patients with deep hematomas larger than 30 cm(3) and 24 patients with a lobar hemorrhage compressing eloquent regions who underwent microsurgical (endoscopic or neuronavigation assisted) clot aspiration. Results: In eight (9%) of the patients in the MIT group, the CT scan control showed a residual clot smaller than 30% of the initial hemorrhage. The neurological condition 3 months later revealed 24 (26.9%) of these patients having a severe disability and 46 (51.6%) patients independent or slightly disabled. Nineteen patients (21.9%) died or remained vegetative. In the control group, 48 (34.7%) cases showed residual clots (< 30%). Sixty-two (44.9%) patients of thisyroup were severely disabled and only 40 (28.9%) were independent. Thiry-six (26%) patients died or were vegetative. There was a p < 0.001 significant difference in volume of residual clots as well as p < 0.01 for the outcome between the two groups. Conclusions: Adaptin minimally invasive techniques to case selection improves the effectiveness of clot removal and the outcome of the patients with SSICHs.