Liu Huang, Qiurong Yang, Chengping Wu, Runsan Hu, Ying Tang
Trans-sylvian hematoma evacuation combined with LTV was associated with improved cerebral hemodynamics, better ADL-based functional recovery, and fewer postoperative complications in selected patients with HBGH and ventricular extension. Because several severity-related variables and shunt-dependency outcomes were unavailable, prospective multicenter studies are required to confirm its long-term clinical benefits.
BACKGROUND: Hypertensive basal ganglia hemorrhage (HBGH) with intraventricular extension is frequently associated with cerebrospinal fluid (CSF) circulation disturbance, postoperative complications, and poor neurological outcomes. We evaluated a single-stage surgical strategy combining trans-sylvian hematoma evacuation with lamina terminalis ventriculostomy (LTV) in patients with HBGH and ventricular extension.
METHODS: This retrospective cohort study included 70 patients with HBGH (hematoma volume ≥30 mL) and intraventricular extension. Patients who underwent isolated trans-sylvian hematoma evacuation between 2020 and 2021 served as the control group (n = 35), whereas patients treated with trans-sylvian evacuation plus LTV between 2023 and 2024 comprised the combined group (n = 35). Propensity score matching (1:1.5 nearest-neighbor matching, caliper = 0.2) was performed using available baseline variables. Cerebral hemodynamics, ADL-based functional recovery, postoperative complications, and EORTC QLQ-C30 scores were analyzed.
RESULTS: After matching, 20 control patients and 30 combined-procedure patients were included. The combined group showed significantly higher postoperative mean flow velocity and lower pulsatility index at postoperative days 7 and 14 (all P < 0.001). Functional recovery assessed by ADL grades I-II was significantly better in the combined group (76.67% vs. 35.00%, P = 0.003). The overall incidence of postoperative complications was significantly lower in the combined group (6.67% vs. 55.00%, P < 0.001). Although significant differences in EORTC QLQ-C30 scores were observed during follow-up, these findings did not consistently favor the combined procedure and should be interpreted cautiously.
CONCLUSION: Trans-sylvian hematoma evacuation combined with LTV was associated with improved cerebral hemodynamics, better ADL-based functional recovery, and fewer postoperative complications in selected patients with HBGH and ventricular extension. Because several severity-related variables and shunt-dependency outcomes were unavailable, prospective multicenter studies are required to confirm its long-term clinical benefits.