被殼出血軽症例の手術適応について

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We have experienced 11 patients with putaminal hemorrhage which localized lateral to the putamen between April and December in 1976. We treated all of them conservatively. The neurological deficits were remarkably improved in all cases within one month after the onset. Computed tomography and carotid angiogram were analized and we have found the specific findings in all of them. Carotid angiogram revealed "sparing sign of internal capsule" as we have previously reported and Computed Tomography demonstrated no high density area at the level of the body of lateral ventricle in all cases. Based on these findings, we have discussed the mechanism how hematoma destroys the pyramidal tract.<BR>We imagined the triangnlar configulation as shown in Fig. 4. On coronary section, a line can be traced from stria terminalis to insula of the same height. This line is the upper margin of the triangle. The lateral, inferior margin of the triangle is formed by a line starting at this position of insula to the upper end of putamen and the medial, inferior aspect of the triangle can be traced from this point up to stria terminalis. The pyramidal tract passes through this triangle and enters into the posterior limb of internal capsule. This triangle seems to be very vulnerable to destrustion by hematoma because the hemorrhage to extend into directions of the triangle along the lateral margin of the putamen when hematoma is enlarged. If the bleeding further continued, the hematoma progresses into the body of lateral ventricle through the triangle and destroys the posterior limb of internal capsule.<BR>In conclusion, the prognosis of the patient, in which angiogram reveals "sparing sign of internal capsule" or Computed Tomography demonstrates no high density area at the level of the body of lateral ventricle is good. Surgical intervention should not be indicated for such a patient.
The Japanese Society on Surgery for Cerebral Strokeの論文

被殼出血軽症例の手術適応について

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