Role of surgery in hypertensive intracerebral hematoma

A comparative study of 305 nonsurgical and 154 surgical cases

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  • 1 Department of Neurosurgery, Fujita-Gakuen University School of Medicine, Toyoake, Aichi, Japan
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✓ The indications for surgery in hypertensive intracerebral hematoma are still controversial. The reason for this may be: 1) lack of adequate and comparable data in conservative and surgical therapy from the same institution; 2) lack of adequate close follow-up monitoring over an extended period of time; or 3) lack of proper classification of hematomas for comparison of results from different institutions. The authors have treated 459 cases of hypertensive intracerebral hematoma between October, 1975, and July, 1983. The hematomas have been classified according to their mode of extension on computerized tomography. The long-term outcome was assessed on the basis of activity of daily living.

Putaminal hematomas were classified as mild, moderate, severe, and very severe. In general, there was no significant difference in outcome between the surgical and nonsurgical cases; however, the outcome in the moderate and severe hematomas was found to be a little better for the surgical cases in some restricted areas. Thalamic and pontine hemorrhages were classified as mild, moderate, or severe. If the hematoma is localized to the thalamus or pons, and if it extends to the midbrain, there is no indication for surgery; however, in patients with moderate hematomas, the prognosis showed a variable outcome, and the indications for surgery were questionable. In cerebellar hematomas, the authors propose that even a hematoma with a diameter greater than 3 cm might show a good outcome with nonsurgical therapy.

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  • 1.

    Ito Z: [ Hypertensive intracerebral hemorrhage — its diagnosis and operative indications. No To Shinkei 28:227244, 1976 (Jpn) Ito Z: [Hypertensive intracerebral hemorrhage — its diagnosis and operative indications.] No To Shinkei 28:227–244, 1976 (Jpn)

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  • 2.

    Kanaya H, , Nishimura K, & Saiki I, et al: [ Surgical treatment of hypertensive intracerebral hemorrhage. Experience with 174 cases.] Neurol Med Chir 16:1927, 1976 (Jpn) Kanaya H, Nishimura K, Saiki I, et al: [Surgical treatment of hypertensive intracerebral hemorrhage. Experience with 174 cases.] Neurol Med Chir 16:19–27, 1976 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 3.

    Kanaya H, , Yukawa H, & Kanno T, et al: A neurological grading for patients with hypertensive intracerebral hemorrhage and a classification for hematoma location on computed tomography, in: Proceedings of the 7th Conference of Surgical Treatment of Stroke. Tokyo: Neuron, 1978, pp 265270 Kanaya H, Yukawa H, Kanno T, et al: A neurological grading for patients with hypertensive intracerebral hemorrhage and a classification for hematoma location on computed tomography, in: Proceedings of the 7th Conference of Surgical Treatment of Stroke. Tokyo: Neuron, 1978, pp 265–270

    • Search Google Scholar
    • Export Citation
  • 4.

    Kaneko M, , Tanaka K, & Shimada T, et al: Long-term evaluation of ultra-early operation for hypertensive intracerebral hemorrhage in 100 cases. J Neurosurg 58:838842, 1983 Kaneko M, Tanaka K, Shimada T, et al: Long-term evaluation of ultra-early operation for hypertensive intracerebral hemorrhage in 100 cases. J Neurosurg 58:838–842, 1983

    • Search Google Scholar
    • Export Citation
  • 5.

    Katada K, , Kanno T, & Sano H, et al: CT of hypertensive intracerebral hemorrhage findings of superacute stage. J Comput Assist Tomogr 3:554555, 1979 (Abstract) Katada K, Kanno T, Sano H, et al: CT of hypertensive intracerebral hemorrhage findings of superacute stage. J Comput Assist Tomogr 3:554–555, 1979 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 6.

    Kutsuzawa T, , Ito K, & Kawakami H: [ Conservative treatment of hypertensive cerebral hemorrhage: results of 104 patients in acute stage.] Neurol Med Chir 16:2936, 1976 (Jpn) Kutsuzawa T, Ito K, Kawakami H: [Conservative treatment of hypertensive cerebral hemorrhage: results of 104 patients in acute stage.] Neurol Med Chir 16:29–36, 1976 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 7.

    Mitsuyama F, , Ishiyama N, & Kanno T, et al: [ Clinical investigation of the acute cerebrovascular disease. Part 1: Cerebrovascular disease of the brainstem.] Jpn J Stroke 2:326332, 1980 (Jpn) Mitsuyama F, Ishiyama N, Kanno T, et al: [Clinical investigation of the acute cerebrovascular disease. Part 1: Cerebrovascular disease of the brainstem.] Jpn J Stroke 2:326–332, 1980 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 8.

    Paillas JE, & Alliez B: Surgical treatment of spontaneous intracerebral hemorrhage. Immediate and long-term results in 250 cases. J Neurosurg 39:145151, 1973 Paillas JE, Alliez B: Surgical treatment of spontaneous intracerebral hemorrhage. Immediate and long-term results in 250 cases. J Neurosurg 39:145–151, 1973

    • Search Google Scholar
    • Export Citation
  • 9.

    Scott M, & Werthan M: The fate of hypertensive patients with clinically proven spontaneous intracerebral hematomas treated without intracranial surgery. Stroke 1:286300, 1970 Scott M, Werthan M: The fate of hypertensive patients with clinically proven spontaneous intracerebral hematomas treated without intracranial surgery. Stroke 1:286–300, 1970

    • Search Google Scholar
    • Export Citation
  • 10.

    Zadeh J, , Lazorthes Y, & Tremoulet M, et al: [ The surgical approach to spontaneous intracerebral hematomas.] Acta Neurochir 31:223226, 1975 (Fre) Zadeh J, Lazorthes Y, Tremoulet M, et al: [The surgical approach to spontaneous intracerebral hematomas.] Acta Neurochir 31:223–226, 1975 (Fre)

    • Search Google Scholar
    • Export Citation

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