Effects of craniopuncture and drainage of intracerebral hemorrhage on brain edema and neurological outcome

Abstract

Objective To investigate the effects of craniopuncture and drainage for the treatment of intracerebral hemorrhage on brain edema and neurological outcome. Methods A total of 62 hypertensive patients with basal ganglia hematoma were selected. These patients were randomly divided into minimally invasive group (n = 32) and medical treatment group (n = 30). Patients of minimally invasive group were treated by craniopuncture and drainage through frontal approach. After surgery patients were given basic treatment: hemostatic agents, antibiotics, dehydration, hypertensive control and nutritive support. Patients of medical treatment group were only treated with medicine. An image process software was used to measure the volume of hematoma and brain edema. The difference in rebleeding rate, time course of complete clot absorption, brain edema volume on the first day and the third day and neurological outcome were compared between the 2 groups. Drainage time, percentage of clot removal and surgery complications were recorded to evaluate the safety of minimally invasive surgery. Results There was no rebleeding case in the 2 groups. Clot evacuation by craniectomy was performed on 6 patients (20%) in medical treatment group for severe brain edema and cerebral herniation in the first 3 d. Time course of complete clot absorption in minimally invasive group [(7.41 ± 5.84) d] was significantly lower than the medical treatment group [(23.15 ± 8.49) d; t = 9.897, P = 0.000]. On the third day edema volume in medical treatment group [(58.42 ± 11.56) ml] was significantly higher than the minimally invasive group [(8.47 ± 7.76) ml; t = 20.242, P = 0.000]. No cases of puncture⁃related bleeding, infection and death were found in the minimally invasive group. The favorable outcome rate in minimally invasive group was 93.75% (30/32), significantly higher than 66.67% (20/30) in the medical treatment group at 6 months later (P = 0.007). Conclusion The craniopuncture and drainage of intracerebral hematoma could reduce the degree of brain edema after intracerebral hemorrhage and improve neurological outcome.

DOI：10.3969/j.issn.1672-6731.2011.02.021