Spontaneous intracerebral haematomas. Clinical and computertomographic findings and long-term outcome after surgical treatment

Abstract

Fifty-four patients, aged 15 to 81 years had a spontaneous intracerebral haematoma surgically removed (51 patients) or had ventricular drainage. One-third had arterial hypertension. Two thirds were alert or drowsy preoperatively and two thirds presented with hemiparesis or decerebrate rigidity. Lobar haematomas constituted 72%, deep supratentorial constituted 21% and cerebellar haematomas 7%. Volume of the haematomas ranged from 10 to 205 ml. 10 patients died in the early postoperative phase and 8 patients died later. Among 36 survivors, 35 were evaluated 15-115 months postoperatively. 10 had resumed part of their earlier occupation. Another 12 were incapacitated and the remaining 13 patients needed nursing care. No patient was neurologically or neuropsychologically intact, but 19 had only slight disabilities. CT-changes at follow-up ranged from no abnormalities at all to low-density lesions, possibly associated with dilatation of a lateral ventricle or porencephaly depending on the size of the haematoma and possible ventricular penetration. Surgical evacuation of ICH is recommended in lobar or deep supratentorial haematomas exceeding 20 ml except in patients older than 60 already unconscious. Smaller haematomas with intraventricular extension may benefit from ventricular drainage or, in the fossa posterior, even from evacuation in case of increasing brain stem compression.

Reliability assessment of computerized tomography scanning measurements in intracerebral hematoma

“…16,21 Although size or volume may influence surgery-related decisions, 15 the actual surgical accessibility of the clot is deemed more important. Lobar hematomas and those located nearer to the cortical surface are much more likely to be surgically treated than those located deeper in the thalamus and putamen.…”

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

“…The natural course of "compromised cerebral blood flow velocities" in one case excluded from our protocol: In serial TCD recordings, (A) "compromised cerebral BFVs and PI values" were recorded before clinical worsening, but her family declined our advice for surgical intervention later. (B-D) Although somewhat global hypaeremia, (E) she had low BFVs one week later and has maintained in a vegetative state in a follow-up period of 6 months not achieve a decreased morbidity and mortality [14,16,26,27]. There seems to be no difference in late results between surgical and conservative groups, although patients in surgical groups were generally in a worse condition and had larger haematoma [8,26,27].…”

“…Clinically, decreased CBF may occur in patients with normal or abnormal neurological function and is possibly related to the effects of acute, transient increased intracranial pressure, haematoma formation, mass effect, reduced metabolism demand, or local squeezing of the microcirculation [10,15,[20][21][22]. Tanizaki [14] used Xe-133 inhalation and SPECT in 13 patients with subacute HPH and investigated changes of CBF after stereotaxic aspiration. He found improvement of postoperative CBF in two thirds of patients.…”

“…The optimal mode of treatment for hypertensive putaminal haemorrhage (HPH) remains a controversial subject despite the improvement of diagnostic and therapeutic modalities [2,4,8,9,14,17,26]. 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].…”

The results of surgery for intracerebral hematomas

“…Many neurosurgeons prefer the operative treatment in spite of only moderate results and perioperative mortality [6,8]; others see no essential advantage in a primarily operative procedure and prefer conservative treatment [2,5]. Most experienced clinicians know of cases with progressive deterioration who improved significantly after operation.…”