Basal ganglia hematoma optimal treatment

The total 30-day mortality rate of patients with basal ganglia haematomas of 30 ml or more and ICH scores of 1 was significantly lower in the surgical group than in the conservative group. For the patients with ICH scores equal to 2, the 30-day mortality rate was obviously decreased in the surgical group compared with that that in the conservative group. It demonstrated that hematoma clot evacuation could limit the brain edema and local ischaemia.

The 30-day mortality rate of patients with basal ganglia haematomas volume of ≥ 30 ml and signs of brain herniation was up to 90% even the hematoma was evacuated surgically within 24 h after the ictus. In a study of Liu et al., 16 of 18 patients with signs of herniation died within 1 week. The possible explanation was that only removal of haematomas might be insufficient to relieve the increased intracranial hypertension. The intra-cranial hypertension would increase again to severe values in few hours because of brain swelling.
Furthermore, the patients with ICH scores equal to 3, the 30-day mortality rate was higher in the surgical group than in the conservative group. Therefore, Treatment should be individualised for patients with basal ganglia haemorrhages. The ICH score was highly associated with the 30-day mortality rate of patients with basal ganglia haemorrhages, which was similar to other studies.
Therefore, the ICH score would provide a standard assessment tool, which can be determined rapidly and easily, for treatments selection of patients with hypertensive basal ganglia haemorrhage.
This study demonstrated that surgical intervention would decrease the 30-day mortality rate of patients with hypertensive basal ganglia haematomas of ≥ 30 ml and ICH scores of 1 or 2. But this retrospective study had some limitations. The hematoma removal was through different surgical procedures. Some patients with large haematoma didn’t receive surgical intervention because of economy; However, a subset of patients with basal ganglia hematoma volume of < 30 ml and shift of midline ≥ 5 mm received surgical removal of hematoma. A more definitive conclusion will be achieved from the future trial 1).
1) Liu H, Zen Y, Li J, Wang X, Li H, Xu J, You C. Optimal treatment determination on the basis of haematoma volume and intra-cerebral haemorrhage score in patients with hypertensive putaminal haemorrhages: a retrospective analysis of 310 patients. BMC Neurol. 2014 Jul 4;14:141. doi: 10.1186/1471-2377-14-141. PubMed PMID: 24996971; PubMed Central PMCID: PMC4090634.

Tendencias en la lesión cerebral traumática severa

Hay una reducción del 13% en la frecuencia de TCE grave desde el primero hasta el último periodo de tiempo. Un aumento en la media de edad 35 a 43 años, mientras que la frecuencia de TCE grave según el sexo seguía siendo aproximadamente el mismo durante las últimas décadas de la vida. Se observó un cambio notable en el mecanismo de la lesión; los accidentes de tráfico se redujeron de 76% a 55%, particularmente aquellos que involucran vehículos de 4 ruedas. Sin embargo, las caídas aumentaron significativamente, en especial en las mujeres mayores, y la contusión y hematoma subdural fueron las lesiones estructurales más frecuentes. Las puntuaciones motoras no fue posible evaluar de forma fiable durante el último período de tiempo debido a la intubación temprana y el uso de drogas sedantes ((Gómez PA, Castaño-Leon AM, de-la-Cruz J, Lora D, Lagares A. Trends in epidemiological and clinical characteristics in severe traumatic brain injury: Analysis of the past 25 years of a single centre data base. Neurocirugia (Astur).
2014 Jul 3. pii: S1130-1473(14)00072-4. doi:  0.1016/j.neucir.2014.05.001. [Epub ahead of print] PubMed PMID: 24998417.))

A Prospective, Randomised, Double-blind, Placebo-controlled Study to Examine the Effectiveness of Burst Spinal Cord Stimulation Patterns for the Treatment of Failed Back Surgery Syndrome

Spinal cord stimulation (SCS) for the treatment of chronic pain is a well-established therapy. However, the requirement that paresthesia be continually felt by the patient has important downsides.
Twenty patients with failed back surgery syndrome (FBSS) and a preexisting SCS system each received three treatment allocations in random order for a period of one week: 500-Hz tonic stimulation, burst stimulation, and placebo stimulation. The primary outcome measure was pain intensity measured on a numerical rating scale (NRS). Secondary outcome measures were pain quality measured using the Short Form McGill Pain Questionnaire (SFMPQ) and safety. Additional data were collected relating to pain-related disability measured using the Oswestry Disability Index (ODI).
The lowest mean NRS and SFMPQ scores were observed under burst stimulation. For the burst stimulation treatment group, mean NRS and SFMPQ scores were significantly decreased compared with the other treatment groups. Mean NRS and SFMPQ scores were not significantly different between 500-Hz tonic stimulation and placebo stimulation. Although the lowest mean ODI score was observed under burst stimulation, no significant differences were found between the ODI categories. No adverse events occurred, and burst stimulation was significantly preferred by 16 patients (80%).
Overall, burst stimulation resulted in significantly better pain relief and improved pain quality in the short term compared with 500-Hz tonic stimulation and placebo stimulation and was preferred by the majority of patients 1).
1) Schu S, Slotty PJ, Bara G, von Knop M, Edgar D, Vesper J. A Prospective, Randomised, Double-blind, Placebo-controlled Study to Examine the Effectiveness of Burst Spinal Cord Stimulation Patterns for the Treatment of Failed Back Surgery Syndrome. Neuromodulation. 2014 Jul;17(5):443-50. doi: 10.1111/ner.12197.
WhatsApp WhatsApp us
%d bloggers like this: