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KMID : 0377619770330030265
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Korean Jungang Medical Journal
1977 Volume.33 No. 3 p.265 ~ p.274
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Surgical Treatment in 122 Cases of Hypertensive Intracerebral Hemorrhage
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고용호/Ko, Yong Ho
이규창/이헌재/Lee, Kyu Chang/Lee, Hun Joe
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Abstract
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The results of surgical treatment of 122 patients with hypertensive intracerbral hemorrhage, which included 66 putamen (extracapsular), 20 thalamus (intracapsular), 15 sub cortex (superficial), 15 ventricle, 3 pons and 3 cerebellum, admitted to the Department of Neurosurgery of Yonsei Medical College from February 1969 to Flay 1977 are summarized as follows;
1) There were 122 cases, 73 men and 49 women.
The highest incidence comprising 77 cases (63.1%) was found in the 5th and 6th decades.
2) In 66 cases, the hemorrhage was situated in the putamen.
Not only was this the most common location, but also the results of surgical treatment were favorable in this extracapsular type.
3) By time period measured from onset until operation, mortality occurred in 46 cases out of 80 (57.5%) within 24 hours; in 5 cases out of 28 (17.9%) within 2-5 days; and in 3 cases out of 14 (21.4%) after 5 days or more. Mortality was highest in cases operated on within 24 hours of onset. Overall mortality was 54 cases out of 122 (44.3%).
4) In 19 cases of simple drainage or partial evacuation of hemorrhage, there was one death and. 18 survivals. of these, 11 cases (57.9%) showed favorable recovery. Although these results may partially be due to the fact that there were many mild cases in this group, nevertheless, all things considered, this procedure produced the best results.
5) In 75 cases of radical evacuation of hemorrhage, 15 cases (20%) showed favorable recovery and 40 cases (53.3%) died, thus showing the highest mortality of the three surgical procedures.
6) In 28 cases of ventriculostomy or extraventricular drainage, 4 cases (14.3 %) showed favorable recovery and 13 cases (46%) died.
7) Preoperative blood pressure, level of consciousness, CSF pressure, site of hemorrhage, onset-operation interval and method of operation were all factors affecting the prognosis and these were discussed.
On the basis of this experience, in many cases of hypertensive intracerebral hemorrhage with stabilized vital and neurological sign, surgery is performed 2-5 days after onset. And although the radical evacuation technically becomes much easier with the use of an operating microscope, the procedures of simple drainage or partial evacuation of hemorrhage under local anesthesia are also recommended in mild cases with slight hemorrhage or even extremely severe cases with massive hemorrhage.
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