bubble_chart Overview

Traumatic basal ganglia hematoma is a special phenomenon discovered only after the widespread use of CT. According to Macpherson (1986), its incidence accounts for 3.1% of traumatic brain injuries and is classified into two types: one is simple basal ganglia hematoma, and the other is complex basal ganglia hematoma, which is combined with other intracranial hematomas and has a poorer prognosis.

bubble_chart Pathological Changes

The injury mechanism is often due to torsion or shear forces caused by acceleration or deceleration injuries, which tear the small blood vessels entering the basal ganglia through the white matter. The hematoma is typically around 20–30 ml in volume. When the volume is larger, it may rupture into the ventricles, causing intraventricular hemorrhage and worsening the condition.

bubble_chart Clinical Manifestations

The clinical manifestation of this disease is characterized by early complete hemiplegia after head injury, with relatively mild disturbance of consciousness.

bubble_chart Diagnosis

Early diagnosis relies on CT scans, and the decision for surgery should be based on the size of the hematoma, the extent of involvement, and whether the condition can be stabilized.

bubble_chart Treatment Measures

If the patient's consciousness improves after injury, the hematoma is less than 30ml, intracranial pressure does not exceed 3.33kPa (25mmHg), CT shows no severe compression of the ventricles or cisterns, midline shift is less than 10mm, and the hematoma has not ruptured into the ventricles, palliative treatment can be considered. Otherwise, surgical intervention should be performed as early as possible.

Surgical approach: For simple basal ganglia hematomas, a drilling and puncture drainage procedure can be used. This involves drilling or coning a hole in the frontal or temporal region, avoiding critical functional areas of the brain, and performing targeted puncture of the hematoma as indicated by CT. Carefully aspirate the liquid portion of the hematoma; if 60% of the accumulated blood can be removed, the goal of decompression is achieved. A catheter is then placed for postoperative drainage, and the wound is sutured. If necessary, urokinase can be injected several times under CT monitoring to promote liquefaction and drainage of the solid blood clot. If a simple basal ganglia hematoma has ruptured into the ventricles, direct ventricular puncture and catheter drainage should be performed.

For complex basal ganglia hematomas accompanied by ipsilateral intracranial hematomas, it is best to design a bone flap or bone window craniotomy based on the CT-indicated location, addressing both hematomas through a single approach. If the surgery cannot be completed in one session or if the lesions are located on opposite sides, in addition to performing a craniotomy to remove the complex hematoma, a bone window craniotomy or at least an expanded drilling method should be used for the basal ganglia hematoma. The cerebral cortex is incised via the lateral fissure or superior temporal gyrus, and the basal ganglia hematoma is removed under direct visualization to achieve thorough hemostasis and prevent postoperative rebleeding.