外側型脳内出血に対する超早期手術:-特にCT導入後の問題点について-

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Since 6 years ago, we have performed 80 cases of per-acute operation for the lateral type of intracerebral hematoma, or the operation until 6 or 7 hours after the apopletic attack. Now, we consider, is the time to reevaluate this operation from the aspect of time factor by application of the computerized tomography (CT).<BR>During the past 6 years we admitted 650 cases of cerebrovascular disease in which there were 145 cases of the lateral type of intracerebral hematoma. 114 cases of them had surgical treatment in which 80 cases or 70% of all were operated in the per-acute stage and 14 others were operated until 24 hours after the attack.<BR>Since the CT was adopted in our hospital last year, we admitted 49 cases of the lateral type of intracerebral hematoma. They included 12 cases of mild type or localized small hematoma which were all treated conservatively and improved. 4 cases of the fulminant type showed decerebrate rigidity already on admission and were excluded from the surgical group. After all, 20 cases were operated in the per-acute stage in which 14 cases were moderate type and 6 others were severe type. Observing by CT in the per-acute stage, the grading of disturbance of consciousness was basically parallel to the size of intracerebral hematoma. Long-term functional prognosis was also parallel to the grading of disturbance of consciousness in this stage.<BR>We will present a case of the moderate type on conservative treatment in which she was stuporous in the per-acute stage showing the moderate size of the hematoma, then gradually became comatous developing severe cerebral edema. She developed into decerebrate rigidity on the following day and died 48 hours after the attack. On the autopsy brain, the hematoma itself was not increased its size but the secondary midbrain hemorrhage seemed to be the cause of death due to the massive cerebral edema.

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古場群己
浜松医療センター脳神経外科

外側型脳内出血に対する超早期手術:-特にCT導入後の問題点について-

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