Indications for surgical treatment of intracerebral hemorrhage

Tedeschi, G; Bernini, F.P.; Cerillo, A

doi:10.3171/jns.1975.43.5.0590

Cited by 23 publications

(3 citation statements)

References 6 publications

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“…10,37,41,42,45,46 It has not been established whether morbidity can be lessened by immediate or delayed removal of a hematoma in a patient with a stable moderate or severe neurological deficit. Reports of single cases and small series suggest that surgery may diminish late morbidly 10,37,[39][40][41][46][47][48] When a hematoma in any location is associated with a history and finding of severely increased intracranial pressure and brain stem compression, emergency surgery is considered depending on the findings on CT scan and physical examination and the initial response to medical therapy. Surgery is generally not undertaken if there is massive hemorrhage with loss of pupillary reaction and brain stem function and no response to the medical therapy.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Spontaneous brain hemorrhage.

Ojemann¹,

Heros²

1983

Stroke

117

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Spontaneous brain hemorrhage accounts for about 10% of all strokes and is fatal in about 50% of the cases. Its incidence, in contrast to other types of strokes, has not declined. Hypertension accounts for about half of these hemorrhages; the rest are due to tumors, aneurysms and vascular malformations, inflammatory and degenerative vasculopathies and hematologic and iatrogenic disorders of coagulation. In some patients no cause is ever found. Hypertensive brain hemorrhage occurs in the deep gray nuclei of the hemispheres, the cerebellum, and the pons and results in specific clinical syndromes depending on the location. Computerized tomography has revolutionized the diagnosis of brain hemorrhage and is resulting in the development of rational criteria for medical and surgical management of these lesions. Intensive medical therapy guided by clinical status and continuous monitoring of ICP may improve outcome. Surgical removal of the hematoma is indicated in lobar and putaminal hemorrhages when the patient is deteriorating in spite of vigorous medical therapy. In addition most large (greater than 3 cm) cerebellar hemorrhages, as well as smaller cerebellar hemorrhages that result in significant brain stem compression should be evaluated. The roles of intensive medical therapy, elective late surgery and of immediate operation in improving eventual functional outcome need to be investigated further.

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Section: Surgical Treatmentmentioning

confidence: 99%

Spontaneous brain hemorrhage.

Ojemann¹,

Heros²

1983

Stroke

117

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“…The principal problem that a strict comparison between surgical and conservative treatment is difficult gave the stratification of severity of the disease [7,16,24,25]. Recently, HPHs are more often operated on by CT-guided stereotaxic surgery instead of conventional open surgery, and many authors stressed the usefulness of this procedure [7,24].…”

Section: Introductionmentioning

confidence: 99%

Application of transcranial Doppler sonography in surgical aspects of hypertensive putaminal haemorrhage

Lee¹,

Chio²,

Lin³

et al. 1996

Acta neurochir

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From May 1992 to February 1993, 22 cases of hypertensive putaminal haemorrhage (HPH) treated at our hospital were serially measured with transcranial Doppler (TCD) sonography. Among them, 13 patients underwent surgical intervention (3 stereotaxic surgery and 10 craniotomies), and 9 were conservatively treated. Most of the patients of the two operative groups had larger haematomas and developed clinical and/or neurological deterioration, which was the indication for subsequent surgery. Therefore the groups represent different clinical and physiological entities. On admission, the peak MCA velocities (Vs) in the surgical group (stereotaxic and craniotomy) were significantly lower than those in the conservative group (mean +/- S.E.M.: 38.33 +/- 4.26 and 42.00 +/- 2.62 cm/sec vs. 57.22 +/- 3.23 cm/sec; p < 0.005, respectively). The surgical group also had significantly lower diastolic (Vd) and mean (Vm) velocities than those of the conservative group (p < 0.001). Rather, the admission pulsatility indices (PI = (Vs-Vd)/Vm) in the surgical group were significantly higher than those of the conservative group (mean +/- S.E.M.: 1.42 +/- 0.04 and 1.31 +/- 0.09 vs. 0.95 +/- 0.01; p < 0.005, respectively). Time course velocity curves reached a peak around the 3rd hospital day in all the 3 groups. The Glasgow coma scale (GCS) scores positively correlated with the mean MCA velocities (n = 22; r = 0.63, p < 0.005; y = 2.04 x + 8.74), but negatively with PI values on admission (n = 22; r = -0.53, p < 0.05; y = 1.68-0.053 x). On the 7th hospital day, 2 patients with peak MCA velocities below 50 cm/sec had an unfavourable outcome. All the 3 patients in the stereotaxic group had higher peripheral resistance, as compared with those in conservative craniotomy groups (mean +/- S.E.M.: 1.28 +/- 0.13 vs. 0.99 +/- 0.07 and 0.87 +/- 0.06; p < 0.05, respectively). Our study supports TCD as a safe and valid monitoring method in patients with HPH. "Compromised cerebral haemodynamic status" (Vs < 50 cm/sec, Vd < 15 cm/sec, Vm < 25 cm/sec, PI > 1.15) may offer an aid in the decision for surgical intervention in HPH. Postoperatively, patients who made a favourable recovery had a significant increment in the MCA velocities in contrast to those severely disabled, whose MCA velocities remained low.

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“…Όσον αφορά την ηλικία δεν διαπιστώθηκαν άξιες λόγου διαφορές θνησιμότητας συντηρητικής -χειρουργικής θεραπείας εύρημα με το οποίο συμφωνούν και άλλοι συγγραφείς (10,25,57,92,112,128,158), ενώ άλλοι υποστήριξαν ότι η προ χωρημένη ηλικία έχει γενικά ένα επιβαρυντικό ρόλο (27,91,95,96,122,161) και αποτελεί μία από τις αντενδείξεις χειρουργικής θεραπείας (122). Το συμπέρασμα μας για τη ση μασία της ηλικίας στην έκβαση ανεξάρτητα από το είδος της θεραπείας (συντηρητική -χειρουργική) είναι ότι η ηλικία δεν επηρρεάζει την έκβαση κατά ουσιαστικό τρόπο.…”

Section: συζητησηunclassified

Αυτόματα Ενδοεγκεφαλικά Αιματώματα

Σάκας¹

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Indications for surgical treatment of intracerebral hemorrhage

Cited by 23 publications

References 6 publications

Spontaneous brain hemorrhage.

Spontaneous brain hemorrhage.

Application of transcranial Doppler sonography in surgical aspects of hypertensive putaminal haemorrhage

Αυτόματα Ενδοεγκεφαλικά Αιματώματα

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