大脳基底核部出血大血腫例(脳室穿破を伴った)の外科的治療:-特にその手術適応限界とその判定法-

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The authors discussed in this paper how to select the appropriate patients for surgical treatment, who had large basal ganglionic hemorrhage with ventricular rupture. The case materials consist of 32 surgically and 25 conservatively treated cases. In the majority of them, levels of consciousness were more worse than somnolence at admission. All of 25 conservatively treated cases had death within 2 weeks of onset. From findings of 16 autopsied brains, the patterns of ventricular hemorrhage could be classified to 3 types such as total and partial hematocephaly, and slight invasion of hematom into ventricule. Clot evacuations were carried out in 32 cases. Out of them, 7 cases (28%) died within 1 month after onset. To clarify the reversible function of brain stem, it is necessary that a large amount of Mannitol® is rapidly administrated. If such patients, whose ciliospinal reflexes are preserve, could obtain improvement of neurological signs after administration of Mannitol®, craniotomies should be performed as soon as possible. For patients with large basal ganglionic hemorrhage with ventricular rupture, it is neccessary that evacuation of intracerebral and intraventricular clots and continuous ventricular drainages are carried out simultaneously. Futhermore, for some cases of them, external decompression should be perfomed after evacuation of clots.