Determining the optimal hematoma volume-based thresholds for surgical and medical strategies in basal ganglia hemorrhage

Abstract Background The indication for surgical intervention in spontaneous intracerebral hemorrhage remains controversial, particularly regarding the benefits of early hematoma drainage via open craniotomy. This study aimed to identify the maximum hematoma volume suitable for conservative treatment and the volume that represents an absolute indication for surgery in patients with basal ganglia hemorrhage. Methods A retrospective analysis was performed on the medical records of patients admitted for basal ganglia hemorrhage from 2019 to 2021. The data encompassed personal history, general information and diagnostic imaging records, particularly CT brain scans from the initial ER visit, were examined to ascertain hematoma volume. The comparison focused on evaluating the outcomes of patients who received medical treatment compared to those who underwent surgical intervention, mainly considering various hematoma volumes, and was conducted using multivariate logistic analysis. Results In a study of 387 cases of basal ganglia hemorrhage, analysis of medical treatment alone across various hematoma volumes revealed that the group with volumes between 10 and 39.9 ml showed no significant difference in mortality compared to the group with volumes less than 10 ml. The Receiver Operating Characteristics (ROC) curve identified a 45.3 ml cutoff for survival prediction with medical treatment alone. Notably, patients in the subgroup undergoing surgical intervention with a hematoma volume less than 30 ml exhibited significantly higher mortality than those who did not undergo surgery. Conversely, there was a pronounced and statistically significant trend toward increased survival in the group with a hematoma volume of at least 60 ml. Conclusions The application of medical treatment alone is suitable for hematoma volumes ranging from 0 to 45.3 ml, whereas volumes of 60 ml or more serve as a clear indication for surgical intervention in patients with basal ganglia hemorrhage.