Effects of minimally invasive techniques for evacuation of hematoma in basal ganglia on cortical spinal tract from patients with spontaneous hemorrhage: observed by diffusion tensor imaging

Objective: To observe the effect of minimally invasive removal of intracranial hematoma in basal ganglia on cortical spinal tract (CST). Methods: Twenty-seven patients with intracerebral hemorrhage (ICH) in basal ganglia were selected and divided into a minimally invasive treatment group (13 patients) and a medical treatment group (14 patients) randomly: the volume of hematoma was 30-50 ml, with an average of 39.20 +/- 4.85 ml in minimally invasive group and 38.70 +/- 6.33 ml in medical treatment group. All patients underwent the whole brain diffusion tensor imaging (DTI) in 1 week after onset; fractional anistropy (FA) values of CST in internal capsule and cerebral peduncle ipsilateral and contralateral to the hematoma side in minimally invasive group were determined and then compared with those in medical treatment group. Results: The minimally invasive treatment group showed that FA values of CST in internal capsule and cerebral peduncle on the affected side were 0.524 +/- 0.045 and 0.534 +/- 0.020, respectively, and in medical treatment group, FA values were 0.425 +/- 0.050 and 0.468 +/- 0.040, respectively. FA values of internal capsule and cerebral peduncle CST in minimally invasive treatment group were significantly increased as compared with the medical treatment group, and a significant difference was noted. In minimally invasive group, we obtained pre-operative DTI in five patients; FA values of CST in internal capsule and cerebral peduncle ipsilateral to the hemorrhage side were 0.428 +/- 0.032 and 0.515 +/- 0.048, respectively, 1 week after the hematoma was evacuated FA values of CST in internal capsule and cerebral peduncle increased significantly. Therefore, minimally invasive surgery for evacuation of intracranial hematomas could reduce the damages to CST. At the same time, the CST which was oppressed and displaced by hematoma restored to normal position largely or completely after the minimally invasive removal of intracranial hematoma. Conclusions: The changes of CST could be visualized by DTI in patients with ICH. Minimally invasive removal of intracranial hematoma could effectively reduce the injury to the CST and could restore the CST which was oppressed and displaced by the hematoma to the normal position.