The effects on prognosis of surgical treatment of hypertensive putaminal hematomas through transsylvian transinsular approach

Kaya, Ramazan; Türkmenoğlu, Osman; Ziyal, Ibrahim M.; Dalkılıç, Türker; Şahin, Yüksel; Aydın, Yunus

doi:10.1016/s0090-3019(02)01043-1

Cited by 46 publications

(33 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The median GCS score was 10 (range 9-11), the median mRS score was 5 (range , and the median NIHSS score was 22 (range [17][18][19][20][21][22][23][24][25][26][27]. All patients' GCS scores improved by at least 2 points.…”

Section: Resultsmentioning

confidence: 99%

“…Intracerebral hemorrhage incites ICP elevation by sev eral distinct mechanisms. Initially, the hematoma volume itself, which can expand for up to 24 hours after the ictus, 7,12,13,22,23,33 impacts the intracranial volume buffer capacity. Subsequently, osmotically active proteins in the hematoma cause edema formation in the surrounding tissue, with approximately 75% of patients experiencing an increase in perihematomal edema within the first 24 hours.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Decompressive hemicraniectomy without clot evacuation in dominant-sided intracerebral hemorrhage with ICP crisis

Heuts

Bruce

Zacharia

et al. 2013

FOC

View full text Add to dashboard Cite

Object Large intracerebral hemorrhage (ICH), compounded by perihematomal edema, can produce severe elevations of intracranial pressure (ICP). Decompressive hemicraniectomy (DHC) with or without clot evacuation has been considered a part of the armamentarium of treatment options for these patients. The authors sought to assess the preliminary utility of DHC without evacuation for ICH in patients with supratentorial, dominant-sided lesions. Methods From September 2009 to May 2012, patients with ICH who were admitted to the neurological ICU at Columbia University Medical Center were prospectively enrolled in that institution's ICH Outcomes Project (ICHOP). Five patients with spontaneous supratentorial dominant-sided ICH underwent DHC without clot evacuation for recalcitrant elevated ICP. Data pertaining to the patients' characteristics and outcomes of treatment were prospectively collected. Results The patients' median age was 43 years (range 30–55 years) and the ICH etiology was hypertension in 4 of 5 patients, and systemic lupus erythematosus vasculitis in 1 patient. On admission, the median Glasgow Coma Scale (GCS) score was 7 (range 5–9). The median ICH volume was 53 cm3 (range 28–79 cm3), and the median midline shift was 7.6 mm (range 3.0–11.3 mm). One day after surgery, the median decrease in midline shift was 2.7 mm (range 1.5–4.6 mm), and the median change in GCS score was +1 (range −3 to +5). At discharge, all patients were still alive, and the median GCS score was 10 (range 9–11), the median modified Rankin Scale (mRS) score was 5 (range 5–5), and the median NIHSS (National Institutes of Health Stroke Scale) score was 22 (range 17–27). Six months after hemorrhage, 1 patient had died, 2 were functionally dependent (mRS Score 4–5), and 2 were functionally independent (mRS Score 0–3). Outcomes for the patients treated with DHC were good compared with 1) outcomes for all patients with spontaneous supratentorial ICH admitted during the same period (n = 144) and 2) outcomes for matched patients (dominant ICH, GCS Score 5–9, ICH volume 28–79 cm3, age < 60 years) whose cases were managed nonoperatively (n = 5). Conclusions Decompressive hemicraniectomy without clot evacuation appears feasible in patients with large ICH and deserves further investigation, preferably in a randomized controlled setting.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Decompressive hemicraniectomy without clot evacuation in dominant-sided intracerebral hemorrhage with ICP crisis

Heuts

Bruce

Zacharia

et al. 2013

FOC

View full text Add to dashboard Cite

show abstract

“…Various surgical approaches have been described to evacuate large, hypertension-based ICHs, including craniotomy and transcortical, 10,13 transsylvian, 6 and transcallosal 7 approaches. In addition, stereotactic aspiration with or without the use of fibrinolytic agents 8,11,17 has also been described.…”

Section: Discussionmentioning

confidence: 99%

Neuroendoscope-assisted evacuation of large intracerebral hematomas: introduction of a new, minimally invasive technique

Bakshi

Banerji³

2004

FOC

View full text Add to dashboard Cite

Object The aim of this study was to describe a new, minimally invasive technique for the endoscopic evacuation of intracerebral hematomas (ICHs) and the clinical and radiological outcomes in patients who underwent the procedure. The authors used a multifunctional three-in-one endoscopic instrument that combines a 0°, 4-mm rigid telescope, an irrigation cannula, and a cautery electrode. Methods In 13 patients a small keyhole craniotomy was made through noneloquent cortex to gain access to the hematoma. After opening the dura mater, a small cortical tunnel (~6 mm in diameter) was created using bipolar forceps and suction to enter into the clot. The three-in-one endoscope was then introduced to provide illumination and irrigation inside the cavity. The clot was safely aspirated under endoscopic vision and constant irrigation by performing microsurgical suction with the other hand. Hemostasis could be achieved using electrocautery and Surgicel. This technique eliminates the use of an endoscopic sheath, thus providing more maneuverability to the neurosurgeon. The brilliant illumination provided by the endoscope and the possibility of using electrocautery in the depths of the brain combined with the increased maneuverability make this technique valuable. Near-complete hematoma evacuation was achieved in 11 (85%) of 13 patients. There were four deaths (30%). Conclusions Safe and effective evacuation of large ICHs is possible by using the three-in-one endoscopic device. Appropriate indications for surgery in patients with large intracerebral hemorrhage must be developed.

show abstract

“…По дан-ным ряда аналогичных исследований [22][23][24][25], при проведении декомпрессивной краниотомии боль-ным с объемом ПГ более 60 мл летальность состав-ляет 10-35%, негрубая инвалидизация наступает у 5-20% выживших. Указывается на улучшение функционального исхода при трансинсулярном удалении ПГ при декомпрессивной краниотомии [27][28][29]. В случае удаления ПГ объемом более 30 мл с проведением декомпрессивной краниото-мии летальность составляет 11-34%, а негрубая инвалидизация наступает у 15-27% [30,31].…”

Section: хирургическое лечениеunclassified

Regression models of interrelationships between clinical and neurobiological parameters in treatment of manic-delusional conditions in attack-like schizophrenia

Изнак¹,

Изнак²,

Klyushnik³

et al. 2016

Z. nevrol. psikhiatr. im. S.S. Korsakova

View full text Add to dashboard Cite

The effects on prognosis of surgical treatment of hypertensive putaminal hematomas through transsylvian transinsular approach

Cited by 46 publications

References 29 publications

Decompressive hemicraniectomy without clot evacuation in dominant-sided intracerebral hemorrhage with ICP crisis

Decompressive hemicraniectomy without clot evacuation in dominant-sided intracerebral hemorrhage with ICP crisis

Neuroendoscope-assisted evacuation of large intracerebral hematomas: introduction of a new, minimally invasive technique

Regression models of interrelationships between clinical and neurobiological parameters in treatment of manic-delusional conditions in attack-like schizophrenia

Contact Info

Product

Resources

About