Objective        To evaluate the effect of minimally invasive evacuation on small to medium hypertensive intracerebral hemorrhage (ICH) in basal ganglia by diffusion tensor imaging (DTI).       Methods       A total of 101 patients with small to medium hypertensive ICH in the basal ganglia who were hospitalized in our department during June 2010 to October 2011 were enrolled

and prospectively divided into 2 matched groups

a minimally invasive treatment group (n=52) and a non-surgical group (n=49). Their volume of hematoma was 15 to 36 ml

with an average volume of 23.36±7.24 ml. All patients received DTI scanning within 48 h after intracerebral hemorrhage and in 14 d after onset. Fractional anisotropy (FA) and diffusion tensor tracto-graphy (DTT) of corticospinal tract (CST) in the affected and unaffected side were obtained. The minimally invasive treatment group was divided into A sub-group (1 to 2 grade

n=22) and B sub-group (3 grade

n=30) according to the integrity of CST. The data were compared between minimally invasive treatment group and medical treatment group

and also between A sub-group and B sub-group.       Results        The initial DTI scanning showed that FA values of CST in internal capsule and cerebral peduncle of affected side were significantly decreased as compared with the unaffected side

and there was no significant difference between two groups (P0.05). The second DTI scanning displayed that FA values of internal capsule (0.49±0.02) and cerebral peduncle (0.47±0.03) in minimally invasive treatment group were significantly increased as compared with the non-surgical group (0.39±0.02

0.43±0.03) (P0.05)

respectively. The recovery extent of CST in minimally invasive treatment group were better than the non-surgical group

which suggested minimally invasive treatment were superior to non-surgical group. The post-operative FA values of A sub-group (0.51±0.02) were higher than B sub-group (0.48±0.02) (P0.05) in minimally invasive treatment group

which meant the less injury of CST was the better outcome of operation.       Conclusion       Minimally invasive treatment is a good method for small to medium hypertensive ICH in basal ganglia

especially when CST is displaced and deformed (1 to 2 grade) by DTT.