高血圧性脳出血の手術経験:-主として大脳基底核部出血例-

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We treated 42 patients with hypertensive intracerebral hematomas from September 1967 through April 1976. Operative cases numbered 29, in whom 25 cases were with hematomas of the basal ganglia and other four were pontine hemorrages (2), frontal and temporal homatomas. In this paper, we discussed on the results of the surgical procedures to these patients, 21 men and 4 women from 23 to 67 years old (mean age: 50.6 years), with hematomas of the basal ganglia. In order to evacuate hematomas totally of these patients, we operated on with three ways of approaches to them and unfortunate postoperative deaths in each group were as follows: 1) transfrontal lobe; 9 of 14 cases, 2) transtemporal lobe; 1 of 6 (in earlier years), 3) transsylvian fissure (this approach has been used recently under microsurgical techiniques); none of 5. Thus the frontal lobe approach had the worst operative results, however, we think that this is one of the useful approaches especially in the cases of ventricle hematoma or medial type of hemorrhage of the basal ganglia. But the operative results of these patients were concerned closely with the preoperative consciousness, therefore we classified the patients under the classification of consciousness of British Medical Research Council. In spite of the early operation in cases of severe conscious disturbance within 48 hours from onsets of the attacks, 3 of 3 comatose patients, 2 of 3 semicomatos, 4 of 7 Confusion Grade III, 1 of 10 Confusion Grade I-II, and none of 2 clear cases died native diseases and/or complications (respiratory failure, gastric hemorrhage, uremia, postoperative rebleeding and pneumonia) in hospital or in the follow-up period. The over-all mortality rate was 10 of 25 (40%). In 15 survived cases, recovery to their previous work was seen in 8 cases, partial disability in 5, and total disability in the remaining 2. Above all 4 of 6 patients with hematoma of the right side had better ability than 4 of 9 with the left side. The main causes of the disability were aphasia and right hemiparesis. The above-mentioned complications were difficult to treat and they became the cause of the deaths.

高血圧性脳出血の手術経験:-主として大脳基底核部出血例-

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