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Oh H, Sim SY, Choi JY, Shim YS, Oh SY, Park SK, Kim MJ, Lim YC, Chung J. The effect of hematoma evacuation with decompressive craniectomy on clinical outcomes in patients with parenchymal hematoma type 2 of hemorrhagic transformation after middle cerebral artery infarction. Neurol Res 2022; 44:894-901. [DOI: 10.1080/01616412.2022.2066784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Hyeongcheol Oh
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sook Young Sim
- Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Republic of Korea
| | - Jin Young Choi
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yu-Shik Shim
- Department of Neurosurgery, Inha University College of Medicine and Hospital, Incheon, Republic of Korea
| | - Se-Yang Oh
- Department of Neurosurgery, Inha University College of Medicine and Hospital, Incheon, Republic of Korea
| | - Sang Kyu Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myeong Jin Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Yong Cheol Lim
- Department of Neurosurgery, Ajou University College of Medicine and Hospital, Suwon, Republic of Korea
| | - Joonho Chung
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Jianhua X, Zhenying H, Bingbing L, Jian S, Shengping Y, Ye T, Huijie W, Yu L, Rongcai J, Shuyuan Y, Xuejun Y, Jianning Z. Comparison of Surgical Outcomes and Recovery of Neurologic and Linguistic Functions in the Dominant Hemisphere After Basal Ganglia Hematoma Evacuation by Craniotomy versus Endoscopy. World Neurosurg 2019; 129:e494-e501. [PMID: 31150853 DOI: 10.1016/j.wneu.2019.05.193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Hemorrhage in the basal ganglia is a common type of intracerebral hemorrhage and has high mortality and poor prognosis. In our study, we aimed to evaluate surgical outcomes and functional recovery after evacuation of hematoma using either craniotomy or endoscopy. METHODS We analyzed retrospective data from 58 patients with basal ganglia hemorrhage who were treated with hematoma evacuation using either craniotomy or endoscopy. Magnetic resonance imaging and a navigation system were used for calculating hematoma volume and for navigation during surgery. Clinical information and surgical outcomes were recorded. At 6-month follow-up, the recovery of neurologic function and the results of the Aphasia Battery of Chinese test were assessed. RESULTS The endoscopy group showed lower intraoperative blood loss (75.36 ± 45.56 vs. 462.67 ± 120.08 mL, P < 0.001), shorter operation time (1.59 ± 0.30 vs. 4.17 ± 0.86 hours, P < 0.001), and a higher hematoma clearance rate (0.93% ± 0.05% vs. 0.88% ± 0.13%, P = 0.04) than the craniotomy group, respectively. No significant differences in mortality were identified, but a trend toward lower mortality in the endoscopy group was apparent (7.14% in the endoscopy group vs. 16.67% in the craniotomy group, P = 0.43). Assessment of neurologic recovery indicated significant differences in the modified Rankin Scale grades between the 2 groups (χ2 = 4.381, P = 0.036). Listening comprehension and speaking ability were also better in the endoscopy group than the craniotomy group (χ2 = 4.693, P = 0.03). CONCLUSIONS Evacuation by endoscopy had better surgical outcomes, recovery of neurologic function, and aphasia recovery than evacuation by craniotomy. It appears that endoscopy is the surgical treatment of choice for middle-aged and elderly patients with a basal ganglia hemorrhage volume of >35 mL.
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Affiliation(s)
- Xiong Jianhua
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Tianjin, China; Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Han Zhenying
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Tianjin, China; Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Liu Bingbing
- Department of Pathology, Third Central Hospital of Tianjin, Tianjin, China; Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Sun Jian
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Tianjin, China; Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Yu Shengping
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Tianjin, China; Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Tian Ye
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Tianjin, China; Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Wei Huijie
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Tianjin, China; Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Lin Yu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Tianjin, China; Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Jiang Rongcai
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Tianjin, China; Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Yue Shuyuan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Tianjin, China; Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Yang Xuejun
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Tianjin, China; Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Zhang Jianning
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Tianjin, China; Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China.
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Dong J, Jiang Z, Chen J, Huang N, Chen J, Liu G. Evacuation assisted by endoscopy has better efficacy for supratentorial intracerebral hematoma than CT-guided minimally invasive aspiration: a retrospective observational cohort study. Br J Neurosurg 2019; 33:348-351. [PMID: 30693799 DOI: 10.1080/02688697.2018.1559273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jun Dong
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | | | - Jin Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ning Huang
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Junjie Chen
- Department of Neurosurgery, Xi Shan Hospital, WuXi, China
| | - Guodong Liu
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Wu R, Qin H, Cai Z, Shi J, Cao J, Mao Y, Dong B. The Clinical Efficacy of Electromagnetic Navigation-Guided Hematoma Puncture Drainage in Patients with Hypertensive Basal Ganglia Hemorrhage. World Neurosurg 2018; 118:e115-e122. [PMID: 29959072 DOI: 10.1016/j.wneu.2018.06.137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 06/15/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate the clinical efficacy of navigation-guided minimally invasive surgery in patients with hypertensive basal ganglia hemorrhage. METHODS A total of 64 patients with hypertensive basal ganglia hemorrhage were enrolled in this retrospective study. They were divided into a navigation group and a traditional group based on surgical approaches. The data for the 2 groups of patients were analyzed with regard for the hematoma clearance rate, duration of surgery, duration of hospitalization, Glasgow Outcome Scale score at discharge, Barthel index score at 6 months, and postoperative complication rates for rebleeding and pneumonia. RESULTS There were no significant differences in basic characteristics between the 2 groups (P > 0.05). The hematoma clearance rate was significantly lower in the navigation group (49.18 ± 16.76%) than in the traditional group (84.29 ± 6.91%, P < 0.01). The duration of surgery and duration of hospitalization were significantly shorter in the navigation group (55.00 ± 11.89 minutes and 24.25 ± 7.1 days, respectively) than in the traditional group (156.38 ± 47.9 minutes and 32.63 ± 9.8 days, respectively; both P < 0.01). There were also significant differences between the 2 groups in Glasgow Outcome Scale scores (P = 0.006). The Barthel index scores were significantly greater in the navigation group (73.13 ± 18.76) than in the traditional group (57.63 ± 26.63, P < 0.05). There were no significant differences between the 2 groups in the complication rates (P > 0.05). CONCLUSIONS Under certain conditions, compared with standard craniotomy and hematoma evacuation, navigation-guided hematoma puncture aspiration and catheter drainage is simple, effective, and safe as a treatment for hypertensive basal ganglia hemorrhage.
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Affiliation(s)
- Ruhong Wu
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou City, China
| | - Huaping Qin
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou City, China
| | - Zhonghai Cai
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou City, China
| | - Jia Shi
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou City, China
| | - Jiachao Cao
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou City, China
| | - Yumin Mao
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou City, China
| | - Bo Dong
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou City, China.
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Enhanced Neuroprotection of Minimally Invasive Surgery Joint Local Cooling Lavage against ICH-induced Inflammation Injury and Apoptosis in Rats. Cell Mol Neurobiol 2015. [DOI: 10.1007/s10571-015-0245-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ohta T, Murao K, Miyake K, Takemoto K, Nakazawa K. Risk factors for early hemorrhagic complications after endovascular coiling of ruptured intracranial aneurysms. AJNR Am J Neuroradiol 2014; 35:2136-9. [PMID: 24994831 DOI: 10.3174/ajnr.a4033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The risk factors of early hemorrhagic complications after endovascular coiling are not well-known. We identified the factors affecting early hemorrhagic complications, defined as any expansion or appearance of hemorrhage shown by head CT in the initial 48 hours after coiling. MATERIALS AND METHODS We retrospectively reviewed a series of 93 patients who underwent coiling for a ruptured saccular aneurysm between 2006 and 2012 at our hospital. RESULTS Five patients showed early hemorrhagic complications, and all involved an expansion of the existing intracerebral hematoma immediately after coiling. The associated risk factors were accompanying intracerebral hemorrhage at onset (P < .001), postoperative antiplatelet therapy (P < .001), and thromboembolic complications (P = .044). In the accompanying intracerebral hemorrhage group, the associated risk factors were postoperative antiplatelet therapy (P = .044) and earlier initiation of coiling (9.8 ± 6.5 versus 28.1 ± 24.0 hours, P = .023). Early hemorrhagic complications were significant risk factors for worse clinical outcome (modified Rankin Scale, 2.02 ± 2.21 versus 4.4 ± 2.30, P = .022). None of the 93 patients showed further hemorrhage after the initial 48 hours after coiling. CONCLUSIONS The accompanying intracerebral hemorrhage at onset, thromboembolic complications, postoperative antiplatelet therapy, and earlier initiation of coiling were the risk factors for early hemorrhagic complications.
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Affiliation(s)
- T Ohta
- From the Department of Neuroendovascular Treatment, Shiroyama Hospital, Osaka, Japan.
| | - K Murao
- From the Department of Neuroendovascular Treatment, Shiroyama Hospital, Osaka, Japan
| | - K Miyake
- From the Department of Neuroendovascular Treatment, Shiroyama Hospital, Osaka, Japan
| | - K Takemoto
- From the Department of Neuroendovascular Treatment, Shiroyama Hospital, Osaka, Japan
| | - K Nakazawa
- From the Department of Neuroendovascular Treatment, Shiroyama Hospital, Osaka, Japan
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NF-κB activation and cell death after intracerebral hemorrhage in patients. Neurol Sci 2014; 35:1097-102. [PMID: 24510152 DOI: 10.1007/s10072-014-1657-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/23/2014] [Indexed: 12/19/2022]
Abstract
Nuclear factor-κB (NF-κB) plays an important role in secondary damage after intracerebral hemorrhage (ICH). We explored NF-κB activation and the relationship between NF-κB and cell death in the perihematomal brain tissue of patients after ICH. According to the interval between onset of hemorrhage and specimen collection, 53 cases of patients with basal ganglia hemorrhage were divided into six experimental groups: 0-6, 7-12, 13-24, 25-48, 49-96, and >96 h group. Brain tissues of the experimental groups and control group were collected. IL-1β, TNF-α, and NF-κB p65 expressions at the protein level were detected by immunohistochemistry. Cell death was detected by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) assay. All of the detection items of immunohistochemistry and TUNEL showed significant differences between the experimental groups and control group. At the protein level, nuclear NF-κB p65, IL-1β, and TNF-α achieved maximum values at 13-48, 0-24, and 13-48 h, respectively. Maximum cell death was reached at 13-48 h. NF-κB activation increased dramatically in perihematomal brain tissue after ICH. NF-κB activation was closely related with cell death and had an important function in secondary brain damage after ICH in patients.
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Wang L, Wu G, Sheng F, Wang F, Feng A. Minimally invasive procedures reduce perihematomal endothelin-1 levels and the permeability of the BBB in a rabbit model of intracerebral hematoma. Neurol Sci 2012; 34:41-9. [PMID: 22311641 DOI: 10.1007/s10072-012-0962-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 01/23/2012] [Indexed: 11/30/2022]
Abstract
To observe the effects of minimally invasive procedures for the evacuation of intracerebral hematomas on perihematomal ET-1 expression and their correlation with blood-brain barrier (BBB) permeability. Forty-five rabbits (2.8-3.4 kg body weight) were randomly divided into a normal control group (NC group, 15 rabbits), a model control group (MC group, 15 rabbits) and a minimally invasive group (MI group, 15 rabbits). A model of intracerebral hemorrhage (ICH) was prepared in the MC and MI groups by infusing autologous arterial blood into the rabbits' brains; the same procedure was also performed in the NC group but without infusing blood into the rabbits' brains. The intracerebral hematomas were evacuated by a stereotactic procedure in the minimally invasive group 6 h after the model was established. The neurological functions, ET-1 expression and the perihematomal BBB permeability were determined and analyzed in all of the animals. The number of endothelial cells with ET-1-positive expression and the perihematomal BBB permeability significantly increased 1, 3, and 7 days after the ICH model was prepared successfully, as compared to the NC group. In the MI group, however, both measurements decreased markedly compared with the MC group at the same time point. A positive correlation between the number of endothelial cells with ET-1-positive expression and BBB permeability was observed. Increased BBB permeability might be associated with perihematomal ET-1 levels. Minimally invasive procedures for the evacuation of intracerebral hematomas could significantly decrease BBB permeability in perihematomal brain tissues, likely by reducing the production of ET-1.
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Affiliation(s)
- Likun Wang
- Department of Neurology, Affiliated Hospital, Guiyang Medical College, Guiyang, Guizhou 550004, People's Republic of China
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Wu G, Zhong W. Effect of minimally invasive surgery for cerebral hematoma evacuation in different stages on motor evoked potential and thrombin in dog model of intracranial hemorrhage. Neurol Res 2009; 32:127-33. [PMID: 19726015 DOI: 10.1179/016164109x12478302362617] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To observe the effect of minimally invasive surgery for cerebral hematoma evacuation in different stages on motor evoked potential (MEP) and thrombin in dog model of intracranial hemorrhage. METHODS Twenty dogs were selected to prepare the intracranial hemorrhage model, which were randomly divided into 6, 12, 18 and 24 hour groups, respectively. The animals in each group underwent a minimally invasive surgery to evacuate the cerebral hematoma after the models were prepared. Before and after procedures, Purdy score, MEP and thrombin in hematoma region were determined and compared. RESULTS Significant decreases in Purdy score, latency of MEP and thrombin expression were observed in 6 and 12 hour groups as compared with the 18 and 24 hour groups (p<0.01). DISCUSSION In the present experiment, we established a dog model of intracranial hemorrhage, which was minimally invasive, easy to operate, highly repeated, simulating the pathological and physiological changes of clinical hypertensive intracranial hemorrhage. Both the latency of MEP and the expression of thrombin decreased after evacuation of intracranial hematoma in early stages by minimally invasive procedures, indicating that minimally invasive procedures for cerebral hematoma in ultra-early and early stages might be more effective to limit brain injury and decrease the latency of MEP and thrombin expression.
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Affiliation(s)
- Guofeng Wu
- Department of Emergency, Guiyang Medical College, No. 28 Guiyi Street, Liuguangmen, Guiyang 550004, China.
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Nishikawa T, Ueba T, Kajiwara M, Miyamatsu N, Yamashita K. A priority treatment of the intraventricular hemorrhage (IVH) should be performed in the patients suffering intracerebral hemorrhage with large IVH. Clin Neurol Neurosurg 2009; 111:450-3. [PMID: 19231066 DOI: 10.1016/j.clineuro.2009.01.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 11/20/2008] [Accepted: 01/10/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND In patients suffering from intracerebral hemorrhage (ICH) with ventricular hemorrhage (IVH), the IVH severity is thought to be associated with prognosis. Therefore, treating IVH may be a beneficial therapeutic target. In this study, by examining the associations among IVH severity, hydrocephalus, initial level of consciousness and prognosis, we attempted to identify which grade of IVH severity should be considered for surgical treatment. METHODS One hundred twenty-nine patients with spontaneous supratentorial ICH treated in our hospital between 2005 and 2006 were screened in this study. Of these patients, 100 with an ICH volume less than 60 ml were categorized into either the ICH patients without IVH (no-IVH) group (n=65) or the ICH patients with IVH (IVH) group (n=35). The Karnofsky Performance Status (KPS) scale assessed at the time of discharge was employed as an outcome index, and a KPS score of <or=40 was defined as the bedridden state. Age, gender, hemorrhage location, volume of ICH, IVH grade (according to the Graeb score), acute hydrocephalus, surgical ICH removal, and ventricular drainage were selected for univariate analyses with logistic regression. RESULTS Elderly patients, IVH volume, acute hydrocephalus, and poor initial level of consciousness were significantly associated with an unfavorable prognosis in the IVH group. Poor level of consciousness was significantly dependent on acute hydrocephalus, and significantly more occurrences of acute hydrocephalus were found in patients with a high IVH volume (Graeb score >or=6) than in patients with low to moderate IVH volume (Graeb score <or=6). CONCLUSIONS IVH severity influenced the occurrence of acute hydrocephalus and initial level of consciousness, which was significantly associated with prognosis. Our results suggest that priority treatment of the IVH should be given to those ICH patients with IVH admitted with a Graeb score of 6 or more.
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Affiliation(s)
- Tomofumi Nishikawa
- Department of Neurosurgery, Kishiwada City Hospital, Kishiwada, Osaka, Japan.
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