Minimally invasive thalamic hematoma drainage can improve the six-month outcome of thalamic hemorrhage

Objective To explore predictors of the 6-month clinical outcome ofthalamic hemorrhage, and evaluate if minimally invasive thalamic hematoma drainage （THD） could improve its prognosis. Methods A total of 54 patients with spontaneous thalamic hemorrhage were evaluated retrospectively. Clinical data, including demographics, stroke risk factors, neuroimaging variables, Glasgow Coma Score （GCS） on admission, surgical strategy, and outcome, were collected. Clinical outcome was assessed using a modified Rankin Scale, six months after onset. Univariate analysis and multivariate logistic regression analysis were performed to determine predictors of a poor outcome. Results Conservative treatnaent was performed for five patients （9.3%）, external ventricular drainage （EVD） for 20 patients （37.0%）, THD for four patients （7.4%）, and EVD combined with THD for 25 patients （46.3%）. At six months after onset, 21 （38.9%） patients achieved a favorable outcome, while 33 （61.1%） had a poor outcome. In the univariate analysis, predictors of poor 6-month outcome were lower GCS on admis- sion （P = 0.001）, larger hematoma volume （P 〈 0.001）, midline shift （P = 0.035）, acute hydrocephalus （P = 0.039）, and no THD （P = 0.037）. The independent predictors of poor outcome, according to the multivariate logistic regression analysis, were no THD and larger hematoma volume. Conclusions Minimally invasive THD, which removes most of the hematoma within a few days, with limited damage to perihematomal brain tissue, improved the 6-month outcome of thalamic hemorrhage. Thus, THD can be widely applied to treat patients with thalamic hemorrhage.

A case of thalamic hemorrhage-induced diaschisis

Diaschisis refers to a disturbance （inhibition or facilitation） of function in an area remote from the site of a primary brain lesion. Previous studies have confirmed that regional cerebral blood flow and metabolism are noticeably decreased in an infarct region. Transient excessive perfusion appears in the ischemic penumbra, and diaschisis occurs in an area remote from the lesion site, showing decreased regional cerebral blood flow and metabolism. Mirror diaschisis refers to a decrease in oxygen metabolism and blood flow in the ＂mirror image area＂ to the infarct regions in the contralateral hemisphere. In this study, a patient with right thalamic hemorrhage was affected with right arm and leg numbness. At 4 months before onset, magnetic resonance imaging of the head demonstrated lacunar infarcts in the left thalamus; therefore the right arm and leg numbness was not associated with lacunar infarcts in the left thalamus. At 8 days following onset, magnetic resonance imaging reexamination did not reveal the focus that could induce right arm and leg numbness and weakness. Thus, it is suggested in this study that the onset of this disease can be explained by mirror diaschisis. That is, right thalamic hemorrhage leads to decreased blood flow and metabolic disturbance in the contralateral thalamus, resulting in right arm and leg numbness.

Endoscopic surgery for thalamic hemorrhage breaking into ventricles: Comparison of endoscopic surgery, minimally invasive hematoma puncture, and external ventricular drainage

Purpose:Thalamic hemorrhage breaking into ventricles(THBIV)is a devastating disease with high morbidity and mortality rates.Endoscopic surgery(ES)may improve outcomes,although there is no consensus on its superiority.We investigated the efficacy and safety of ES and compared the outcomes of different management strategies by ES,hematoma puncture and drainage(HPD),and external ventricular drainage(EVD)in patients with THBIV.Methods:We retrospectively analyzed patients with THBIV treated by ES,HPD,or EVD at our hospital from June 2015 to June 2018.Patients were categorized into anteromedial and posterolateral groups based on THBIV location,and then the two groups were further divided into ES,HPD,and EVD subgroups.Individualized surgical approach was adopted according to the location of the hematoma in the ES subgroups.Patient characteristics and surgical outcomes were investigated.Results:We analyzed 211 consecutive patients.There were no significant differences in clinical characteristics or incidence of perioperative procedure-related complications(postoperative rebleeding and intracranial infection)in either anteromedial or posterolateral groups.Compared with other therapeutic methods,the ES subgroups had the highest hematoma evacuation rate,shortest drainage time,and lowest incidence of chronic ventricular dilatation(all p<0.05).Among the three anteromedial subgroups,ES subgroup had the best clinical outcomes which was assessed by the modified Rankin Scale,followed by HPD and EVD subgroups(p<0.01);while in the posterolateral subgroups,clinical outcomes in the ES and HPD subgroups were similar and better than that in the EVD subgroup(p=0.037).Conclusion:Individualized surgical ES approach for removal of thalamic and ventricular hematomas is a minimally invasive,safe,and effective strategy for the treatment of THBIV with a thalamic hematoma volume of 10-30 mL.