Indications and limitations for CT-guided stereotaxic surgery of hypertensive intracerebral haemorrhage, based on the analysis of postoperative complications and poor ability of daily living in 158 cases

Abstract

The authors have studied the indications and limitations for computerized tomography (CT)-guided stereotaxic surgery (CTGS Surgery) of hypertensive intracerebral haematomas (ICH), based on the analysis of 158 patients in our institutions. Of 158 patients, 120 had putaminal haemorrhage, 21 thalamic, 14 subcortical and 3 in other locations. The patients ranged in age from 37 to 82 years (average 60). Haematoma volume ranged from 8 to 140 ml (average 43). Eleven patients in the series worsened postoperatively because of rebleeding in 6 cases, cerebral infarction in 2, and unknown causes in the remaining 3 cases. Seven of the 11 patients pre-operatively had untreated hypertension and 3 had mild liver dysfunction without major haemorrhagic tendency. Most postoperative complications were seen in older patients and in those with severe neurological deficit or chronic disease. All these cases ended in poor outcome. From our study, we propose three indications for CTGS Surgery: absolute, aggressive and passive indications. The absolute indication is applied to those who would have been operated on by conventional open surgery. The aggressive indication is for those with mild neurological deficit so that early rehabilitation can be started to regain higher cerebral function. The passive indication is for elderly patients and those with severe neurological deficit or chronic disease. This indication must be decided carefully because poor outcome is likely.

Clinico-Radiological Characteristics and Pathological Diagnosis of Cerebral Amyloid Angiopathy-Related Intracerebral Hemorrhage

“…46 Another study reported that 3.8% of the patients, mostly with putaminal or thalamic hemorrhage, had rebleeding after CT-guided stereotactic surgery; 76% had been performed later than 3 days after symptom onset. 47 The rate of rebleeding and the timing of surgery in our cases fell within the ranges of the results of these previous reports, supporting the relative safety of hematoma evacuation surgery in CAA-ICH. Early surgical treatment might have functional and survival advantage for the patients with spontaneous superficial ICH without IVH [48][49][50] ; however, careful consideration of the indication for surgical intervention and perioperative management is still needed, especially for the patients at high risk of surgical intervention.…”

Effects and Complications of Stereotactic Aspiration for Spontaneous Intracerebral Hemorrhage

“…The incidence of rebleeding in patients with liver dysfunction is approximately three times greater than that in patients with normal liver function. 2,4,6,15) Fibrinogen is a product of the liver, and liver dysfunction also affects the platelet count and prolonged PT or activated partial thromboplastin time. These factors can be indicators of liver function and hemorrhagic tendency.…”

“…The clinical use of stereotactic aspiration for ICH remains controversial. 3,6,12,13) Hematoma evacuation reduces morbidity, shortens hospitalization, promotes the return to activities of daily life, and reduces medical costs. 5) Furthermore, the mortality rate at one month is lower after surgical treatment than after conservative treatment in patients with ICH.…”

“…4,15) Patients with rebleeding after stereotactic aspiration of ICH tend to have liver dysfunction, 15) as highlighted by a few recent reports. 2,6) The present study evaluated the effects and com-Stereotactic Aspiration for Spontaneous ICH plications of stereotactic aspiration for the treatment of ICH, particularly aspiration pneumonia and rebleeding. [6] only by repeated mechanical stimuli; and 3-digit codes: the patient cannot be aroused with any forceful mechanical stimuli, and 100 [7] responds with movements to avoid the stimulus, 200 [8] responds with slight movements including decerebrate and decorticate posture, and 300 [9] does not respond at all.…”

Application of transcranial Doppler sonography in surgical aspects of hypertensive putaminal haemorrhage

“…The principal problem that a strict comparison between surgical and conservative treatment is difficult gave the stratification of severity of the disease [7,16,24,25]. Recently, HPHs are more often operated on by CT-guided stereotaxic surgery instead of conventional open surgery, and many authors stressed the usefulness of this procedure [7,24].…”