Stereotactic aspiration surgery and the treatment of hypertensive intracerebellar hemorrhage.
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The outcomes of 48 patients with hypertensive intracerebellar hemorrhage were investigated. Our series included 13 male and 35 female patients, ranging in age from 44 to 84 years with a mean age of 64.4 years. Of the 48 patients, 22 were treated conservatively and 26 underwent operation: ventricular drainage in 3, suboccipital craniotomy in 10 and stereotactic aspiration surgery (AS) in 13. Kanaya's neurological grade (Grade) on admission was Grade 1 in 10, Grade 2 in 12, Grade 3 in 9, Grade 4a in 5, and Grade 4b or 5 in 12 patients. Conservative treatment was performed in 18 patients at Grades 1 to 4a, of which 17 at Grades 1 to 3 showed good recovery to moderate disability. Fifteen of these 17 patients at Grades 1 or 2 had small hematomas under 10ml. All patients at Grades 4b or 5 showed severe disability, vegetative state or death in outcomes, regardless of the type of treatment. At Grades 1 to 4a, surgical treatment was performed in 18 patients: ventricular drainage in 2, evacuation via suboccipital craniotomy in 4, and AS combined with ventricular drainage in 12 cases. AS was performed by suboccipital trephination using Komai's CT-stereotactic apparatus. AS in the subacute stage was performed in 7 patients atf Grades 1, 2 and 3. The average evacuation rate was 78%, and the symptoms were improved in all patients and resulted in good recovery to moderate disability. In the acute stage, AS was performed within 48 hours of onset in 5 patients at Grades 2 and 3 with aggravating symptoms and at Grade 4a without aggravating symptoms. The average evacuation rate of hematoma was 68% and the symptoms were improved in all patients, and resulted in moderate disability outcomes. To decrease mortality in the acute stage, AS should be appropriately timed to control acute intracranial hypertension by combined ventricular drainage. We conclude that AS for patients at Grade 2 to 4a can provide a good prognoses not only in the subacute, but also in the acute stage of hypertensive intracerebellar hemorrhage.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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