Optimal treatment determination on the basis of haematoma volume and intra-cerebral haemorrhage score in patients with hypertensive putaminal haemorrhages: a retrospective analysis of 310 patients

BACKGROUND: Hypertensive putaminal haemorrhage comprises major part of intra-cerebral haemorrhages, with particularly high morbidity and mortality. However, the optimal treatments for these individuals remain controversial. METHODS: From June 2010 to August 2013, patients with hypertensive putaminal haemorrhages were treated in the Department of Neurosurgery, West China Hospital. Information regarding the age, signs of cerebral herniation, haematoma volume, intra-ventricular haemorrhage, intra-cerebral haemorrhage score and the treatments of each patient were analyzed retrospectively. The outcome was evaluated by the 30-day mortality rate. RESULTS: The 30-day mortality rate of the patients with haematomas volume greater than or equal to 30 ml and intra-cerebral haemorrhage scores of 1 or 2 was decreased in the surgical group compared with those in the conservative group (1.92% VS. 21.40%, OR = 0.072, p = 0.028; 15.40% VS. 33.3%, OR = 0.365, p = 0.248, respectively). The mortality rate of the patients with signs of cerebral herniation was not significantly different between the surgical and conservative groups (83.30% VS. 100%; p = 0.529). The intra-cerebral haemorrhage score was significantly associated with the 30-day mortality rate of patients with intra-cerebral haemorrhages (r = -0.798, p < 0.001). CONCLUSION: Patients with basal ganglia haematomas volume greater than or equal to 30 ml and intra-cerebral haemorrhage scores of 1 or 2 could benefit from the surgical removal of haematomas. The intra-cerebral haemorrhage score can accurately predict the 30-day mortality rate of patients with hypertensive putaminal haemorrhages.