Comparison treatments for basal ganglia hemorrhage: minimally invasive puncture and drainage versus craniotomy versus conservative treatment
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: The optimal management strategies for spontaneous intracerebral hemorrhage in the basal ganglia region are still controversial. The purpose of the present study is to evaluate the clinical benefits of craniotomy, minimally invasive puncture and drainage (MIPD) and conservative treatment in patients with basal ganglia hematoma. Materials & methods: This study retrospectively enrolled consecutive patients with hematoma ≥20 ml in the basal ganglia hemorrhage and onset to admission within 24 h. Primary outcome was the proportion of favorable outcome (modified Rankin scale score 0–3) at 3 months. Secondary outcomes included excellent outcome (modified Rankin scale score 0–2) and mortality at 3 months and 1 year. Sensitive analysis was performed in patients with hematoma ≥ 30 ml. Results: A total of 481 patients were included and divided into three groups: 146 received craniotomy, 211 underwent MIPD and 124 were managed with conservative treatment. The proportion of primary outcome was lower in the craniotomy (23.24%) than in the MIPD (35.41%) and conservative treatment (41.94%) groups. Among patients with hematoma ≥30 ml, MIPD has higher rates of favorable outcome at 3 months (37.32 vs 25.98%, p = 0.05) and 1 year (52.82 vs 40.16%, p = 0.04) compared with craniotomy; albeit. The short-term and long-term mortality was similar in three groups. Conclusion: MIPD was found to be associated with both short- and long-term favorable outcomes in patients with spontaneous intracerebral hemorrhage in the basal ganglia region. Moreover, neither MIPD nor craniotomy showed an association with increased risk of short- or long-term mortality.
Plain language summary: Which treatment works best for deep brain bleeds: minimally invasive drainage, open surgery or medication-only care?
What is this article about?
Patients with sudden bleeding in deep brain regions (basal ganglia hemorrhage) face high risks of disability. This study compared three treatments: open brain surgery (craniotomy), a less invasive drainage procedure (MIPD) and medication-only care (conservative treatment), to see which best preserves patients' independence.
What were the results?
MIPD was found to be associated with both short- and long-term favorable outcomes in patients with spontaneous intracerebral hemorrhage in the basal ganglia region. Moreover, neither MIPD nor craniotomy showed an association with increased risk of short- or long-term mortality.
Why is this important?
Doctors often debate whether surgery helps deep brain bleeds. This study shows that less invasive options (minimally invasive drainage or careful monitoring) may improve recovery more than open surgery, without increasing death risk. For large bleeds, minimally invasive drainage appears to offer the best chance for independence. These findings could potentially steer treatment toward safer, more effective approaches – especially where resources for complex surgery are limited.
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References
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Received: 16 June 2025
Accepted: 23 October 2025
Published online: 27 November 2025
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Comparison treatments for basal ganglia hemorrhage: minimally invasive puncture and drainage versus craniotomy versus conservative treatment. (2025) Journal of Comparative Effectiveness Research. DOI: 10.57264/cer-2025-0097
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