高血圧性脳出血の手術適応決定のための新重症度分類の提唱

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Surgical treatment of hypertensive intracerebral hematoma has become popular in Japan. But the operative criteria of it is clarified not yet. We proposed a new clinical grading for the hypertensive putaminal hemorrhage according to the level of consciousness within six hours after the onset and the location of hematoma. Grade 1: normal to mild disturbance of consciousness with the hematoma of localized type. Grade 2: mild to moderate disturbance of consciousness with an advanced type (to the posterior limb of the internal capsule). Grade 3: moderate to severe disturbance of consciousness with an advanced type (to the ventricle). Grade 4: Grade 34+ over 60 year-old+ dominant side lesion. Grade 5: very severe disturbance of consciousness with an advanced type. The disturbance of consciousness means the level of consciosness which reached a maximum point within 6 hours after the onset. The basis of this grading is the fact that the primary brain damage caused by the hematoma is the most important prognostic factor of the disease. The location of hematoma can be recognized by the cerebral angiography and CAT. The primary brain damage may be represented by the level of disturbance of consciousness which reached a maximum point within 6 hours after the onset because the hematoma formation is accomplished during the time in most cases. Comparing the 175 operative results of putaminal hemorrhage with the outcome of 79 conservatively treated cases, we concluded as to management of the disease as follows. Grade 1: medical treatment Grade 2: medical treatment surgical treatment for deteriorating cases Grade 3: surgical treatment Grade 4, 5: medical treatment surgical treatment (if possible, within 6 hours after the onset)
The Japanese Society on Surgery for Cerebral Strokeの論文

高血圧性脳出血の手術適応決定のための新重症度分類の提唱

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