The puncture aspiration in surgery of putamenal hemorrhages
Objective. To analyze the efficacy of routine puncture aspiration in surgical treatment of putamenal hemorrhages Material and methods. The retrospective analysis of surgical treatment outcomes at 27 patients with putamenal hemorrhages was conducted. All patients underwent routine aspiration of intracerebral hematoma using universal technique. The operations were conducted under local anesthesia. The mean age of patients was 55 (37-70) years old, 22 were men, women - 5. The mean value of preoperative level of consciousness was 13 (10-15) scores according to GCS. The mean preoperative value of hemiparesis was 1,4 (0-2) scores. The preoperative volume of hematoma was 47 (25-80) ml, the average value of brain shift was 6,1 (3-12) mm. All patients were divided into 3 groups according to time of operation: 1st group (n=6) - operation was performed during first 2 days of disease, 2d group (n=16) - 3-7th days of disease, 3d group (n=5) - 8th day of disease and more. The estimation of treatment outcomes in relation to side of hematoma was conducted as well as the estimation of functional outcome. Results. Lethality was 44% (12 patients died). Lethality was 67% among patients with hematoma in left hemisphere and 17% - at patients with hematoma in right hemisphere. The mean value of hemiparesis at survived patients was 2,1 (0-3) scores at discharge. The mean percentage of evacuated hematoma during operation at patients of various groups was the follow: 1st group - 64% of initial volume of hematoma, 2d group - 53%, 3d group - 77%. The accuracy of reaching the center of hematoma was 74%. The development of severe perifocal edema without hematoma relapse but with repeated development of expressed brain shift was observed at 3 patients in spite of regress of brain shift in early postoperative period and small residual volume of hematoma on 3-4th days after operation. One patient suffered from relapse of hematoma on the 2d day after operation. Conclusion. The routine aspiration was the effective method for removal of putamenal hematoma in conducted study. The usage of such technique allowed achieving the rapid regress of brain shift and partial regress of neurological deficit at majority of patients.