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Decompressive hemicraniectomy in large putaminal hematomas: an Indian experience.
J Stroke Cerebrovasc Dis. 2009 Jan; 18(1):1-10.JS

Abstract

OBJECTIVE

The treatment of large putaminal hematomas is predominantly medical and the role of surgery is debated. Decompressive hemicraniectomy in large hemispheric infarctions has been reported to lower mortality and improve outcomes. Decompressive hemicraniectomy may also have a role in putaminal hematomas.

METHODS

In all, 23 patients with putaminal hematoma who underwent decompressive craniectomy in the last 4 years were analyzed. Parameters investigated included clinical presentations, radiologic profile, time interval from ictus to surgery, and Glasgow outcome score at 1 month.

RESULTS

There were 13 men and 10 women with ages ranging from 31 to 68 years. All of them presented with neurologic deficits. Seven patients had a Glasgow Coma Scale (GCS) score of 3 to 8, 12 had a GCS score of 9 to 12, and GCS score was above 13 in 4. Seventeen patients had known hypertension. Computed tomography scan was done in all. The hematoma was less than 3 cm in 5 cases, 3 to 5 cm in 11, and larger than 5 cm in 7; and was 30 mL or less in 3, 30 to 60 mL in 13, and more than 60 mL in 7. All patients underwent hemicraniectomy on the side of the lesion and dura was left open. At 3 months, 13 patients had a good outcome and 10 had a poor outcome (including 3 deaths).

CONCLUSIONS

Decompressive hemicraniectomy can be a useful alternative surgical procedure in moderate to large putaminal hematomas.

Authors+Show Affiliations

Department of Neurosurgery, Dr SMCSI Medical College, Karakonam, India. r_ramnarayan@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19110137

Citation

Ramnarayan, R, et al. "Decompressive Hemicraniectomy in Large Putaminal Hematomas: an Indian Experience." Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, vol. 18, no. 1, 2009, pp. 1-10.
Ramnarayan R, Anto D, Anilkumar TV, et al. Decompressive hemicraniectomy in large putaminal hematomas: an Indian experience. J Stroke Cerebrovasc Dis. 2009;18(1):1-10.
Ramnarayan, R., Anto, D., Anilkumar, T. V., & Nayar, R. (2009). Decompressive hemicraniectomy in large putaminal hematomas: an Indian experience. Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, 18(1), 1-10. https://doi.org/10.1016/j.jstrokecerebrovasdis.2008.09.001
Ramnarayan R, et al. Decompressive Hemicraniectomy in Large Putaminal Hematomas: an Indian Experience. J Stroke Cerebrovasc Dis. 2009;18(1):1-10. PubMed PMID: 19110137.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Decompressive hemicraniectomy in large putaminal hematomas: an Indian experience. AU - Ramnarayan,R, AU - Anto,Dominic, AU - Anilkumar,T V, AU - Nayar,Rani, PY - 2008/04/03/received PY - 2008/06/09/accepted PY - 2008/12/27/entrez PY - 2008/12/27/pubmed PY - 2009/2/6/medline SP - 1 EP - 10 JF - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association JO - J Stroke Cerebrovasc Dis VL - 18 IS - 1 N2 - OBJECTIVE: The treatment of large putaminal hematomas is predominantly medical and the role of surgery is debated. Decompressive hemicraniectomy in large hemispheric infarctions has been reported to lower mortality and improve outcomes. Decompressive hemicraniectomy may also have a role in putaminal hematomas. METHODS: In all, 23 patients with putaminal hematoma who underwent decompressive craniectomy in the last 4 years were analyzed. Parameters investigated included clinical presentations, radiologic profile, time interval from ictus to surgery, and Glasgow outcome score at 1 month. RESULTS: There were 13 men and 10 women with ages ranging from 31 to 68 years. All of them presented with neurologic deficits. Seven patients had a Glasgow Coma Scale (GCS) score of 3 to 8, 12 had a GCS score of 9 to 12, and GCS score was above 13 in 4. Seventeen patients had known hypertension. Computed tomography scan was done in all. The hematoma was less than 3 cm in 5 cases, 3 to 5 cm in 11, and larger than 5 cm in 7; and was 30 mL or less in 3, 30 to 60 mL in 13, and more than 60 mL in 7. All patients underwent hemicraniectomy on the side of the lesion and dura was left open. At 3 months, 13 patients had a good outcome and 10 had a poor outcome (including 3 deaths). CONCLUSIONS: Decompressive hemicraniectomy can be a useful alternative surgical procedure in moderate to large putaminal hematomas. SN - 1532-8511 UR - https://www.unboundmedicine.com/medline/citation/19110137/Decompressive_hemicraniectomy_in_large_putaminal_hematomas:_an_Indian_experience_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1052-3057(08)00181-X DB - PRIME DP - Unbound Medicine ER -