Stereotactic Evacuation Performed During the Subacute Phase Improves Functional Independence Measurement Scores in Patients With Putaminal Hemorrhage

INTRODUCTION: Surgery for putaminal hemorrhage during the acute phase does not improve motor and cognitive impairments. We investigated the effect of stereotactic evacuation performed seven days after the onset of putaminal hemorrhage on the Functional Independence Measurement (FIM) score, compared with that of conservative treatment. METHODS: We included 203 patients admitted for putaminal hemorrhage treatment between January 2012 and December 2022. Of these, 28 patients with putaminal hemorrhage (computed tomography classification IVa: putaminal hemorrhage into the anterior and posterior limbs of the internal capsule without ventricular perforation) who did not undergo surgery in the acute phase were divided into stereotactic evacuation (n = 14) and conservative treatment (n = 14) groups. We then evaluated the total, motor, and cognitive FIM scores at three months post admission. RESULTS: Greater average hematoma volume (p = 0.06) and greater perihematomal edema volume (p = 0.07) on admission were observed in the stereotactic evacuation group. We performed stereotactic evacuation 13.6 ± 3.4 days after admission, with an average hematoma removal rate of 91.4%. The total and cognitive FIM scores at three months improved in the stereotactic evacuation group. CONCLUSION: Our findings indicate that stereotactic evacuation in the subacute phase has better functional outcomes, especially in patients with cognitive impairment. Minimally invasive surgery may be a promising option to improve patients' prognoses.