Long insular artery damage might be a key sign for predicting functional prognosis of putaminal hemorrhage

Objective

Although the putamen is the most common area of spontaneous intracerebral hemorrhage, previous reports about the effects of surgery are limited. We sometimes experience a poor prognosis in patients in whom there is no damage to the internal capsule, but with injury in the long insular artery (LIA) region. The purpose of this study was to confirm the relationship between LIA damage and patient prognosis following surgery for putaminal hemorrhage.

Methods

We retrospectively collected data of 287 surgical cases who presented with putaminal hemorrhage between January 2004 and March 2022. Among them, we chose patients without initial damage to the posterior limb of the internal capsule, and divided these patients into two groups, those without (Group A) and with (Group B) final damage in the LIA region. We compared positivity rates of final manual muscle test (MMT) scores ≥ 3 and related factors.

Results

Sixty-three of the 287 patients were included in this study. Of them, 11 cases in Group A were positive for MMT scores ≥ 3 (68.8%) and 9 cases (19.1%) in Group B had MMT scores ≥ 3 seven days after surgery. Group A thus had a significantly higher rate of MMT scores ≥ 3 than group B (p = 0.00).

Conclusion

In patients without initial damage to the internal capsule, LIA injury might be a key sign for predicting the functional prognosis of putaminal hemorrhage.