The evaluation of surgical treatments for putaminal hemorrhage by means of single-photon-emission CT

Twenty-two patients with mild putaminal hemorrhage (neurological grades 1 and 2) were divided into three groups. Four (conservative group) received conservative treatment. Thirteen (aspiration group) underwent CT-guided stereotactic aspiration. Four (craniotomy group) underwent microsurgical evacuation of the hematoma. Surgical treatments were performed within 6 days after the onset. We measured the cerebral blood flow (CBF) using single-photon-emission CT and the 133Xe-inhalation method. The CBF was measured at the acute stage (Days 1-7), at the subacute stage (Days 8-14), and at the chronic stage (one month after the onset). In putaminal hemorrhage with both neurological grades 1 and 2 and with 2 only, the mean hemispheric CBF (mCBF) of the hematoma and the nonhematoma side among the three groups had no significance at any stage. In each group, no improvement in the reduction of mCBF was observed. In putaminal hemorrhage with neurological grade 1 only, however, the mCBF of the hematoma side at the chronic stage was 47.8±6.7 ml/100 g/min in the conservative group and 59.1±7.6 ml/100 g/min in the aspiration group. This difference was statistically significant. In the aspiration group, the mCBF values of both sides and the regional CBF (rCBF)-A·L·P at the chronic stage increased significantly compared with those at the acute and subacute stage. On the other hand, in the conservative group, no improvement in the reduction of CBF at the chronic stage was observed. From the serial measurement of CBF, it was observed that, compared with conservative therapy, CT-guited stereotactic aspiration for putaminal hemorrhage with neurological grade 1 is more effective. (author)