Clinical course of spontaneous gangliothalamic hemorrhage in the acute period--who requires surgical removal?

We analyzed the clinical courses of 93 consecutive patients with gangliothalmic hemorrhage for the first three weeks after the ictus and investigated the factors affecting the clinical course and the final outcome. The clinical status was assessed daily using the Glasgow Coma Score (GCS) and patients were divided into two groups according to the clinical course; Group I included those who improved and Group II consisted of patients who deteriorated. There were 44 patients (47.3%) in Group I and 49 patients (52.7%) in group II. Each group was subdivided into the conservative group and the surgical group. In Group I only eight patients (18.2%) received surgery while twenty-five patients (51.0%) received surgery in Group II. Clinical features and computed tomography characteristics of these four groups were compared. Our results suggested that the surgery is rarely required for patients 1) whose GCS values are 12 or more without deterioration; 2) with hematomas smaller than 3 cm in diameter or 20 ml in volume; 3) with midline shifts of less than 3 mm, and 4) whose subtypes of the hematomas are P1, P2a, T1, T2a, and T2b. For proper comparison of the results of medical and surgical treatment, the patient population should include the patients 1) who became deteriorated progressively regardless of initial GCS values; 2) whose GCS values are below 12; 3) with hematomas larger than at least 3cm in diameter or 20ml in volume; 4) with midline shift of more than 3mm, and 5) whose subtypes of the hematoma are P2b or GT.