Surgical Management of Intracerebral Hemorrhage

Abstract

Intracerebral hemorrhage (ICH), defined as bleeding within the brain parenchyma, remains a challenging and controversial neurosurgical entity to treat. ICH has a broad range of etiology-stemming from complications associated with traumatic head injury to complications of hemorrhagic stroke. The role of medical management lies in optimizing blood pressure and intracerebral pressure, preventing secondary injury from complications of the hematoma such as seizures, and correcting coagulopathy. Given the mass effect of a hematoma and the possibility of expansion, surgical interventions attempt to evacuate the clot to restore normal intracerebral pressure and prevent worsening neurologic injury. This chapter reviews the recent controversy associated with surgical evacuation of intracerebral hemorrhage placing particular emphasis on the size and location of the hemorrhage and the methods used to evacuate the expanding ICH. Moreover, this chapter reviews considerations and therapeutic goals of the preoperative and postoperative window to minimize complications and optimize patient care.

Korelasi antara Skor Intracerebral Hemorrhage (ICH) dengan Mortalitas Pasien Perdarahan Intraserebral di RSUD Ulin Banjarmasin

“…Syarat lainnya diluar skor ICH berupa adanya pergeseran struktur melewati garis tengah ≥5 mm dan atau kompresi pada sisterna. 19 Oleh karena itu, setidaknya komponen skor ICH berupa GCS dan volume yang semakin memberat akan mempengaruhi pengambilan tindakan terapi operatif pada pasien. Akan tetapi, hasil analisis antara terapi dengan mortalitas pasien PIS pada penelitian ini menunjukkan hubungan tidak bermakna (Tabel 6).…”