Minimally invasive thalamic hematoma drainage can improve the six-month outcome of thalamic hemorrhage

Abstract

Objective: To explore predictors of the 6-month clinical outcome of thalamic hemorrhage, and evaluate if minimally invasive thalamic hematoma drainage (THD) could improve its prognosis.

Methods: A total of 54 patients with spontaneous thalamic hemorrhage were evaluated retrospectively. Clinical data, including demographics, stroke risk factors, neuroimaging variables, Glasgow Coma Score (GCS) on admission, surgical strategy, and outcome, were collected. Clinical outcome was assessed using a modified Rankin Scale, six months after onset. Univariate analysis and multivariate logistic regression analysis were performed to determine predictors of a poor outcome.

Results: Conservative treatment was performed for five patients (9.3%), external ventricular drainage (EVD) for 20 patients (37.0%), THD for four patients (7.4%), and EVD combined with THD for 25 patients (46.3%). At six months after onset, 21 (38.9%) patients achieved a favorable outcome, while 33 (61.1%) had a poor outcome. In the univariate analysis, predictors of poor 6-month outcome were lower GCS on admission (P = 0.001), larger hematoma volume (P < 0.001), midline shift (P = 0.035), acute hydrocephalus (P = 0.039), and no THD (P = 0.037). The independent predictors of poor outcome, according to the multivariate logistic regression analysis, were no THD and larger hematoma volume.

Conclusions: Minimally invasive THD, which removes most of the hematoma within a few days, with limited damage to perihematomal brain tissue, improved the 6-month outcome of thalamic hemorrhage. Thus, THD can be widely applied to treat patients with thalamic hemorrhage.

Keywords: Hematoma volume; Minimally invasive; Outcome; Predictor; Thalamic hematoma drainage; Thalamic hemorrhage.

Figure 1.. The CT scan of thalamic hemorrhage before and after THD.

(A): Preoperative CT scan revealing the thalamic hematoma ruptured into the ventricle; (B): portable CT scan during operation showing the suitable position of the THD tube; (C): CT scan three days after operation revealing most of the hematoma removed; and (D): CT scan seven days after operation revealing the thalamic and intraventricular hematoma eliminated completely. The numbers indicate that: 1, drainage tube of THD; 2, drainage tube of EVD, 3, damage to the normal brain tissue caused by THD. EVD: external ventricular drainage; THD: thalamic hematoma drainage.

Figure 2.. The ROC curve of predictors to predict the poor 6-month outcome.

The AUC of no THD, GCS score on admission, hematoma volume, acute hydrocephalus on admission and midline shift were 0.645 (95% CI: 0.494–0.796), 0.765 (95% CI: 0.626–0.904), 0.816 (95% CI: 0.704–0.928), 0.643 (95% CI: 0.490–0.796) and 0.641 (95% CI: 0.485–0.796) respectively. AUC: area under ROC curve; GCS: Glasgow Coma Score; ROC curve: receiver operating characteristic curve; THD: thalamic hematoma drainage.