CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(04): 742-750
DOI: 10.1055/s-0043-1776049
Original Article

Surgical Outcome of Basal Ganglia Hemorrhage: A Retrospective Analysis of Nearly 3,000 Cases over 10 Years

1   Department of Emergency Medicine, Institute of Neurosciences, Kolkata, West Bengal, India
2   Department of Emergency Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
3   Department of Neurosurgery, Institute of Neurosciences, Kolkata, West Bengal, India
› Author Affiliations
Funding None.


Background Basal ganglia hemorrhage (BGH) is a severe neurologic condition associated with significant morbidity and mortality, and its optimal management remains a topic of debate. Our study assessed the surgical outcomes of BGH patients at the 3-month mark using the modified Rankin Scale (mRS).

Methods This retrospective observational study was conducted over 10 years at an advanced neuro-specialty hospital in Eastern India, including patients who underwent decompressive craniotomy and hematoma evacuation. Variables were systematically coded and analyzed to evaluate the postoperative outcome with age (in years), preoperative motor (M) status, and hematoma volume.

Results This study enrolled 2,989 patients with a mean age of 59.62 (standard deviation: 9.64) years, predominantly males (n = 2,427; 81.2%). Hypertension (1,612 cases) and diabetes mellitus (1,202 cases) were the most common comorbidities. Common clinical presentations included ipsilateral weakness (1,920 cases) and/or altered mental status (1,670 cases). At the 3-month mark postsurgery, 2,129 cases (71.2%) had a favorable outcome based on mRS, while 389 cases (13.0%) had an unfavorable outcome. The regression equation showed that age was inversely related to the percentage of individuals achieving a favorable outcome. It also revealed that the preoperative motor score was positively correlated with favorable outcomes. Hematomas smaller than 60 mL had better outcomes, with 1,311 cases (69.1%) classified as good outcomes and 337 cases (17.8%) as bad outcomes. Fatal outcomes related to the illness were observed in 471 patients (15.8%) within the study population.

Conclusion Surgery for BGH showed a substantial improvement in outcomes, particularly in patients with M5/M4 motor status. The preoperative motor score (M status) emerged as a crucial predictor of favorable neurological outcomes. Age and hematoma volume, however, were found to be nondefinitive factors in determining good outcomes.

Authors' Contributions

D.H. contributed to concepts, design, definition of intellectual content, literature search, manuscript preparation, manuscript editing, and manuscript review. G.M.C. helped in design, definition of intellectual content, literature search, manuscript preparation, manuscript editing, and manuscript review. A.K.G. was involved in concepts, definition of intellectual content, manuscript editing, and manuscript review. He also provided guarantee.

Publication History

Article published online:
14 December 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 Ziai WC, Carhuapoma JR. Intracerebral hemorrhage. Continuum (Minneap Minn) 2018; 24 (06) 1603-1622
  • 2 Rajashekar D, Liang JW. Intracerebral hemorrhage. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023
  • 3 Caceres JA, Goldstein JN. Intracranial hemorrhage. Emerg Med Clin North Am 2012; 30 (03) 771-794
  • 4 Hsieh JT, Ang BT, Ng YP, Allen JC, King NKK. Comparison of gender differences in intracerebral hemorrhage in a multi-ethnic Asian population. PLoS One 2016; 11 (04) e0152945
  • 5 An SJ, Kim TJ, Yoon BW. Epidemiology, risk factors, and clinical features of intracerebral hemorrhage: an update. J Stroke 2017; 19 (01) 3-10
  • 6 Ariesen MJ, Claus SP, Rinkel GJE, Algra A. Risk factors for intracerebral hemorrhage in the general population. Stroke 2003; 34 (08) 2060-2065
  • 7 Hemphill III JC, Greenberg SM, Anderson CS. et al; American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015; 46 (07) 2032-2060
  • 8 Kreitzer N, Woo D. Overview of Hemorrhagic Stroke Care in the Emergency Unit. In: Lee SH. ed. Stroke Revisited: Hemorrhagic Stroke. Singapore: Springer; 2018: 91-101
  • 9 Canadian Stroke Best Practices [Internet]. [cited 2023 Jun 27]. 1. Emergency Management of Intracerebral Hemorrhage. Accessed September 26, 2023 at:
  • 10 Mendelow AD, Teasdale GM, Barer D, Fernandes HM, Murray GD, Gregson BA. Outcome assignment in the International Surgical Trial of Intracerebral Haemorrhage. Acta Neurochir (Wien) 2003; 145 (08) 679-681 , discussion 681
  • 11 Fu C, Wang N, Chen B. et al. Surgical management of moderate basal ganglia intracerebral hemorrhage: comparison of safety and efficacy of endoscopic surgery, minimally invasive puncture and drainage, and craniotomy. World Neurosurg 2019; 122: e995-e1001
  • 12 Guo W, Liu H, Tan Z. et al. Comparison of endoscopic evacuation, stereotactic aspiration, and craniotomy for treatment of basal ganglia hemorrhage. J Neurointerv Surg 2020; 12 (01) 55-61
  • 13 Jianhua X, Zhenying H, Bingbing L. et al. Comparison of surgical outcomes and recovery of neurologic and linguistic functions in the dominant hemisphere after basal ganglia hematoma evacuation by craniotomy versus endoscopy. World Neurosurg 2019; 129: e494-e501
  • 14 Kolias AG, Kirkpatrick PJ, Hutchinson PJ. Decompressive craniectomy: past, present and future. Nat Rev Neurol 2013; 9 (07) 405-415
  • 15 Mohan M, Layard Horsfall H, Solla DJF. et al; NIHR Global Health Research Group on Neurotrauma. Decompressive craniotomy: an international survey of practice. Acta Neurochir (Wien) 2021; 163 (05) 1415-1422
  • 16 de Oliveira Manoel AL. Surgery for spontaneous intracerebral hemorrhage. Crit Care 2020; 24 (01) 45
  • 17 The ABCs of Measuring Intracerebral Hemorrhage Volumes | Stroke [Internet]. [cited 2023 Jun 27]. Accessed September 26, 2023 at:
  • 18 Ghosh AK. Different methods and technical considerations of decompressive craniectomy in the treatment of traumatic brain injury: a review. Indian J Neurosurg 2017; 06 (01) 36-40
  • 19 Arboix A, Rodríguez-Aguilar R, Oliveres M, Comes E, García-Eroles L, Massons J. Thalamic haemorrhage vs internal capsule-basal ganglia haemorrhage: clinical profile and predictors of in-hospital mortality. BMC Neurol 2007; 7: 32
  • 20 Kellner CP, Schupper AJ, Mocco J. Surgical evacuation of intracerebral hemorrhage: the potential importance of timing. Stroke 2021; 52 (10) 3391-3398
  • 21 Sahuquillo J, Dennis JA. Decompressive craniectomy for the treatment of high intracranial pressure in closed traumatic brain injury. Cochrane Database Syst Rev 2019; 12 (12) CD003983
  • 22 Greenberg SM, Ziai WC, Cordonnier C. et al; American Heart Association/American Stroke Association. 2022 Guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke 2022; 53 (07) e282-e361
  • 23 Fleetwood IG, Marcellus ML, Levy RP, Marks MP, Steinberg GK. Deep arteriovenous malformations of the basal ganglia and thalamus: natural history. J Neurosurg 2003; 98 (04) 747-750
  • 24 Stapf C, Mohr JP, Pile-Spellman J, Solomon RA, Sacco RL, Connolly Jr ES. Epidemiology and natural history of arteriovenous malformations. Neurosurg Focus 2001; 11 (05) e1