高血圧性脳出血に対するfrontal approachについて

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Recently, it seems to be established of carotid angiographycal identification and the operative indication of hypertensive intracerebral hematoma. We have operated 36 cases of hypertensive intracerebral hematoma except thalamic hemorrhage in the past 3 years. Those cases are devided into three groups of location of hematoma in the standpoints of angiographycal findings: 3 cases of suprasylvian anterior type out of 36 cases in total. In this time, we have discussed the significance and the operative indication of this approach after analyzing angiographycal findings of suprasylvian anterior type (frontomedial side). Those results are summarized as belows. 1. Clinically, those cases show disturbed consciousness, choked discs and mild motor disturbance in comparison with other type. 2. The characteristics of findings of carotid angiography show the round shift of ACA, S-shaped configuration of the perforator fairly kept and mild shift of ICV in AP view. On the other hand, in lateral view posterior displacement of sylvian triangle with downward deformity of anterior part, backward displacement and stretch of perforator in concaved form, and backward displacement of thalamostriate vein. 3. Transfrontal approach is useful for intrafrontal hematoma which might be bled from the perforator of ACA including of Heubner artery. 4. Transfrontal approach is better especially in dominant hemisphere. 5. 2 cases out of 3 took satisfactory postoperative course except slight mental dullness.
The Japanese Society on Surgery for Cerebral Strokeの論文

高血圧性脳出血に対するfrontal approachについて

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