The predictive value of stereotactic surgery guided by CTA angiographic point sign for secondary hematoma expansion following surgery in patients with moderate-volume basal ganglia hematoma

TL;DR

Using CTA angiographic point sign during stereotactic surgery helps reduce hematoma expansion and improves outcomes for patients with moderate-volume basal ganglia hematomas.

Contribution

Demonstrates the clinical benefit of CTA angiographic point sign in reducing secondary hematoma expansion after surgery.

Findings

No secondary hematoma expansion occurred in the CTA-guided group, compared to 18.75% in the CT-guided group.

The CTA-guided group had lower mortality and better GCS and MRS scores than the CT-guided group.

CTA-guided surgery reduced postoperative lung infections and improved long-term recovery.

Abstract

To examine the efficacy of the CTA angiographic point sign in forecasting secondary hematoma expansion following stereotactic surgery in patients with moderate-volume basilar ganglia hematoma and it’s potential to enhance postoperative outcomes.

A retrospective analysis was conducted on the clinical data of 143 patients with moderate-volume basal ganglia hematoma (hematoma volume between 30 mL and 60 mL) admitted to the Department of Neurosurgery at Baise People’s Hospital from January 2021 to December 2022. Stereotactic surgery guided by the CTA angiographic point sign was conducted in 79 patients (experimental group), while stereotactic surgery guided by the computed tomography (CT) scan was performed in 64 patients (control group). The short-term clinical results (incidence of secondary hematoma expansion, Glasgow Coma Scale (GCS) score within 30 days, death, surgical complications) and long-term clinical outcomes [Modified Rankin Scale (MRS) score after 6 months] were analysed by comparing the two groups.

No subsequent hematoma expansion occurrences transpired in the experimental group post-surgery, but 12 (18.75%) such events were observed in the control group following the procedure. The experimental group experienced 27 postoperative lung infections (34.18%), whereas the control group had 33 infections (51.56%). The average GCS score was (9.46 ± 2.23) in the experimental group and (7.94 ± 4.68) in the control group. The mortality rate was 2 (2.53%) in the experimental group and 8 (12.50%) in the control group. The treatment efficacy rate (MRS) at 6 months was 59 cases (74.68%) in the experimental group and 35 cases (54.69%) in the control group. The disparity between the two groups was statistically significant (p < 0.05).

CTA angiographic point-guided stereotactic surgery can significantly diminish the incidence of subsequent hematoma expansion following the procedure, enhancing patient clinical outcomes and postoperative quality of life.

Figures