術後死亡した被殼進展型脳出血の手術適応の検討

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Twenty six cases of hypertensive putaminal hemorrhage, excluding the cases with thalamic extension, were examined by CT scan to estimate the volume of hemorrhage. The results were analyzed in relation with the operative mortality and the morbidity in the follow-up study.<BR>The size of the hematoma was figured by measuring the extent of the high density area in each 1 cm slice, and then the value was magnified according to the actual scale. Thus the volume of the hematoma was roughly estimated as the summation of total number of the affected slices.<BR>All of the patients received surgical removal of the hematoma through the sylvian fissure and the operation was performed within 7 hours after onset of the illness in 13 cases, and 23 cases received surgery within 3 days. Five patients died during hospitalization. The operative results and the ADL score obtained at the follow-up study were reviewed with the volume of the hematoma, and were found closely related to the estimated blood volume by preoperative CT scan, irrespective to the side of hemorrhage and the cerebral dominancy. Among 10 cases of ADL 1 or 2 group 7 cases were found to have less than 35 ml. hemorrhage and out of 10 cases of ADL 3 or 4 group only 2 cases showed hemorrhage of less than 40 ml. There were many other known factors complicating the postoperative course of hypertensive cerebral hemorrhage, such as advanced arteriosclerosis with cardio-renal failure, however, the volume of hematoma estimated by CT scan was an important factor indicating the postoperative mortality and morbidity.
The Japanese Society on Surgery for Cerebral Strokeの論文

術後死亡した被殼進展型脳出血の手術適応の検討

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