高血圧性被殼出血重症例の手術経験

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Despite of great progress in neurosurgical managements, prognosis for hypertensive intracerebral hemorrhage is still grave. Among these, hematoma in the putaminal region has been considered to be a good candidate for surgical removal. We have analysed results of surgical treatment for a massive hematoma in this area. The criteria for our selection were as follows: i) diagnosis of putaminal hemorrhage had been made by carotid angiography and/or CT, ii) midline shift was present, iii) there was no embarrassments in vital functions.<BR>Surgical procedures included transcortical evacuation of the hematoma by a moderately large craniotomy and external decompression by patching dural opening and removing the bone flap. Materials for the present analysis were 26 cases in which diagnosis was made within 3 days from an insult.<BR>Final outcome was that the partially disabled were 5 cases (19%), the totally disabled 10 cases (39%), and the dead 11 cases (42%). Factors which bore good prognostic significance were 1) that the level of consciousness was better than deep semicoma, 2) that the location of hematoma was in the non-dominant hemisphere, and 3) that the hematoma had not perforated into the ventricular system. Four out of five partially disabled cases had all 3 factors and none in the totally disabled and the dead.<BR>The difficulty lies in the fact that cases were encountered in which the level of consciousness was better than deep semicoma and showed apparent mass effect by a hematoma in the dominant hemisphere with or without ventricular perforation. Since these patients would be treated surgically by a neurosurgeon even with poor prospect, new tactics in overall management would be needed.

高血圧性被殼出血重症例の手術経験

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