Comparison of conservative treatment and surgical treatment for thalamic hemorrhage in 556 cases. Keio Cooperative Stroke Study.
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The purpose of the present study was to compare the outcome of medical treatment with that of surgical treatment in patients with thalamic hemorrhage. The subjects comprised 556 patients (334 males and 222 females; 64 ± 10 years of age (mean ± SD) admitted to the Department of Neurology and its 10 affiliated neurological institutes and hospital in the past 5 years (from 1984 to 1988). Every patient was diagnosed by brain CT scan within 24 hours after onset. Among the 556 patients with thalamic hemorrhage, 527 were treated by conservative treatment and the remaining 29 patients were treated surgically. The surgical treatment consisted of ventricular drainage in 25 cases, aspiration of the hematoma in 2 cases, evacuation of the hematoma with ventricular drainage in 1 case and aspiration of the hematoma with ventricular drainage in 1 case. The mean age of the surgical group (57 ± 12 years) was significantly (p<0.01) younger than that of the conservative group (64 ± 10 years). The patients were classified on the basis of the neurological grading (NG) on admission, mode of extension on brain CT (CT classification), maximal diameter of the hematoma and volume of the hematoma. The outcome of the patients was evaluated by ADL on discharge. For the classification of the neurological grading, mode of extension on brain CT and ADL, the criteria of the Japan Society for Research on Surgical Treatment for Stroke were employed.<BR>The results obtained were as follows : <BR>1) In mild cases with thalamic hemorrhage (NG, 1, 2, 3; CT classification, Ia, Ib, a; maximal diameter of the hematoma, 2 cm or less; volume of the hematoma, 10 ml or less), the overall prognosis was significantly better in the conservative group.<BR>2) In moderate cases with thalamic hemorrhage (maximal diameter, 2.1-3.0 cm), the functional prognosis was significantly better in the conservative group.<BR>3) In severe cases (CT classification, IIb; maximal diameter of the hematoma, 3.1-4.0 cm; volume of the hematoma; 31 ml or more), the mortality rate was significantly lower in the surgical group, although the functional prognosis of survivors after the operation remained poor.<BR>Based on the above findings, it is suggested that surgical treatment (ventricular drainage) for thalamic hemorrhage should be considered only as a life-saving measure in severe cases.
- 一般社団法人 日本脳卒中学会の論文
一般社団法人 日本脳卒中学会 | 論文
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