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Neurosurgic treatment of spontaneous and traumatic intracerebral hematomas  [PDF]
?urovi? B.M.,Tasi? G.M.,Jovanovi? V.T.,Nikoli? I.M.
Acta Chirurgica Iugoslavica , 2008, DOI: 10.2298/aci0802123d
Abstract: In the period from 01.01.2000 until 31.12.2002 34 patients with spontaneous intracerebral hematoma (ICH) and with deeply disturbed state of consciousness were operated in the Department of neurosurgery of the Urgent Center, Clinical Center of Serbia. In all operated patients the indication for surgery was given on the basis of CT scan of the brain, state of consciousness, defined Glasgow coma score (GCS) and neurological status, but due to existing or threatening incarceration not even one patient was submitted to angiography of the blood vessels at the cerebral base, thus preoperatively we did not know the cause of the hemorrhage. Of 34 operated patients 22 or 64.7% died, and 12 or 35.3% survived. 14 patients were in the deepest phase of coma, where the preoperative GCS is from 3 to 5 points, and in the postoperative course only one survived, aged 25. The other survivors had somewhat less disturbed state of consciousness, they also were younger, CT scan of the brain was without blood in the chamber system. In the same period, in the Department of Neurosurgery of the Urgent Center, Clinical Center of Serbia 43 patients with traumatic intracerebral hematoma (TIH) were operated; 9 patients survived, 34 died. Only 4 patients had acute TIH. All of them were in the terminal stage of incarceration, and despite being immediately submitted to surgery all of them died. The remaining 39 patients had, the so called delayed TIH where the secondary CT scan of the brain showed development of the traumatic intracerebral haematoma that was not verified on the incipient scanner. Indication for a repeated CT scan was given in 19 patients due to focal or general neurological deterioration. However in 20 patients subsequent neurological disturbances were not registered. Those that survived were younger patients, and they were not in the deepest stage of coma, most often they had a temporal localization of hematoma.
Stereotactic fibrinolysis of spontaneous intracerebral hematoma using infusion of recombinant tissue plasminogen activator
Nasser, José Augusto;Falavigna, Asdrubal;Bezerra, Márcio;Martinez, Victor;Freitas, Gabriel;Alaminos, Armando;Bonatelli, Ant?nio;Ferraz, Fernando;
Arquivos de Neuro-Psiquiatria , 2002, DOI: 10.1590/S0004-282X2002000300004
Abstract: purpose: the authors present a prospective study on 10 patients with stereotactic infusion of tissue plasminogen activator (rtpa) intraparenchimal hemorrhage. methods: between 1999 and 2000, 10 patients with deep seated hematomas in the basal ganglia were selected for stereotactic infusion of rtpa and spontaneous clot drainage. results: all cases had about 80% reduction of the hematoma volume in the ct scan at the third day. the intracranial pressure was normalized by the third day too. there were no local or systemic complications with the use of this trombolitic. the results were shown by the glasgow outcome scale with six patients in v, three in iv and one in iii after 3 months. conclusion: early treatment and drainage with minimally invasive neurosurgery , can make these patients with deep-seated hematomas recover the consciousness and they can be rehabilitated earlier avoiding secondary complications.
Stereotactic fibrinolysis of spontaneous intracerebral hematoma using infusion of recombinant tissue plasminogen activator  [cached]
Nasser José Augusto,Falavigna Asdrubal,Bezerra Márcio,Martinez Victor
Arquivos de Neuro-Psiquiatria , 2002,
Abstract: PURPOSE: The authors present a prospective study on 10 patients with stereotactic infusion of tissue plasminogen activator (rtPA) intraparenchimal hemorrhage. METHODS: Between 1999 and 2000, 10 patients with deep seated hematomas in the basal ganglia were selected for stereotactic infusion of rtPA and spontaneous clot drainage. RESULTS: All cases had about 80% reduction of the hematoma volume in the CT scan at the third day. The intracranial pressure was normalized by the third day too. There were no local or systemic complications with the use of this trombolitic. The results were shown by the Glasgow Outcome Scale with six patients in V, three in IV and one in III after 3 months. CONCLUSION: Early treatment and drainage with minimally invasive neurosurgery , can make these patients with deep-seated hematomas recover the consciousness and they can be rehabilitated earlier avoiding secondary complications.
Spontaneous supratentorial intracerebral hemorrhage: Does surgery benefit comatose patients?  [cached]
Yilmaz Cem,Kabatas Serdar,Gulsen Salih,Cansever Tufan
Annals of Indian Academy of Neurology , 2010,
Abstract: Introduction: Treatment of spontaneous supratentorial intracerebral hemorrhage (SICH) is still controversial. We therefore analyzed the comatose patients diagnosed as having spontaneous SICH and treated by surgery. Materials and Methods: We retrospectively analyzed the collected data of 25 comatose patients with initial Glasgow Coma Scale (GCS) ≤ 8 diagnosed as having spontaneous SICH and they had been treated by surgical evacuation between 1996 and 2008. The outcome was assessed using Glasgow outcome scale (GOS). The side and location of the hematoma and ventricular extension of the hematoma were recorded. The hematoma volume was graded as mild (<30 cc), moderate (30-60 cc) and massive (>60 cc). Results: Age of the patients ranged from 25 to 78 years (mean: 59.6 ± 15.14 years). Among the 25 patients studied, 11 (44%) were females and 14 (56%) were males. GCS before surgery was <5 in 8 (32%) patients and between 5 and 8 in 17 (68%) patients. The hematoma volume was less than 30 cc in 2 patients, between 30 and 60 cc in 9 patients and more than 60 cc in 14 patients. Fourteen of the patients had no ventricular connection and 11 of the hematomas were connected to ventricle. All the 25 patients were treated with craniotomy and evacuation of the hematoma was done within an average of 2 hours on admission to the emergency department. Postoperatively, no rebleeding occurred in our patients. The most important complication was infection in 14 of the patients. The mortality of our surgical series was 56%. GCS before surgery was one of the strongest factors affecting outcome GCS (oGCS) (P = 0.017). Income GCS (iGCS), however, did not affect GOS (P = 0.64). The volume of the hematoma also affected the outcome (P = 0.037). Ventricular extension of the hematoma did affect the oGCS and GOS (P = 0.002), but not the iGCS of the patients (P = 0.139). Conclusion: Our data suggest that being surgically oriented is very important to achieve successful outcomes in a select group of patients with SICH.
Hematomas intracerebral espontaneos estudo de 121 casos
Werneck, Lineu Cesar;Scola, Rosana Hermínia;Ferraz, Leila Elizabeth;
Arquivos de Neuro-Psiquiatria , 1991, DOI: 10.1590/S0004-282X1991000100003
Abstract: results are reported on the study of 121 patients commited by spontaneous intracerebral haematomas (hie): mean age 53.4 years, 62.8% males, mean admission time of 36 hours (3 hours to 12 days) from onset; 63.5% were graded over 7 in the glasgow scale and 81.9% were graded 3 or over in the boterell scale. the hie location was 45.5% in the basal ganglia, multilobar in 14.7%, lobar in 22.8%, brain stem in 4%, and cerebelum in 2%. the mean diameter was 46.6 mm (16-93) and mean area was 1422.9 mm2 (60-4818). csf in 67 cases showed mean opening pressure of 234 mmh20 and mean protein content of 416.9 mg/dl. treatment was conservative in 107 cases and surgical in 14; 55.8% cases survived. the majority of patients who died were graded 3 in the boterell scale and below 9 in the glasgow scale. it was found a statistical correlation between death and: low glasgow and high boterell scales grading, motor ocular nerve palsy, motor deficit, decerebration signs, broncopneumonia, large diameter and area of hematomas. no statistical correlation was found regarding survival and treatment with dexametasone, antifibrinolitics, anticonvulsivants, antihypertensive drugs and diuretics. use of manitol, fall in the systolic blood pressure and surgical therapy increased the mortality rate. from 14 patients who underwent surgical drainage, 11 died. the main complication who lead to death was broncopneumonia. a discussion is made on hie pathogenesis, localization, present day incidence, clinical findings, death causes, size of hematomas and type of treatment used.
Tratamiento quirúrgico de la hemorragia intracerebral espontánea: Parte I: Hemorragia supratentorial Surgical treatment for spontaneous intracerebral haemorrhage: Part I: Supratentorial haematomas  [cached]
A. Pérez-Nú?ez,A. Lagares,B. Pascual,J.J. Rivas
Neurocirugía , 2008,
Abstract: La hemorragia intracerebral espontánea (HIE) constituye uno de los procesos ictales de mayor gravedad. A pesar de esto y de una elevada incidencia, su tratamiento médico no va mucho más allá de un papel de soporte vital y control médico de la hipertensión intracraneal, y las indicaciones del tratamiento quirúrgico están pobremente basadas en evidencia científica. El objetivo del presente trabajo fue revisar las bases de la indicación quirúrgica en la HIE supratentorial. Encontramos 10 ensayos clínicos y 5 meta-análisis en lengua inglesa que analizaban la utilidad del tratamiento quirúrgico en esta patología. Aunque globalmente estos estudios no mostraron un beneficio significativo del tratamiento quirúrgico en el conjunto de pacientes con HIE supratentorial, existe un subgrupo de pacientes en los que parece que dicho tratamiento podría ser beneficioso. En la hemorragia intracerebral espontánea supratentorial las recomendaciones actuales indican que los pacientes jóvenes, con hematomas lobares cuyo volumen causa un deterioro del nivel de consciencia, deben ser intervenidos. En pacientes con hematomas putaminales que reúnen las mismas condiciones de edad y deterioro neurológico la cirugía podría mejorar la evolución, al menos en términos de supervivencia. Un grave deterioro neurológico con GCS<5, la localización talámica y la presencia de una situación basal o edad que impidan una adecuada recuperación funcional, son criterios considerados tradicionalmente contraindicación del tratamiento quirúrgico. Dada la ausencia de evidencia científica sólida en la que sustentar estas recomendaciones, la decisión terapéutica debe realizarse de manera individualizada y prestando atención al soporte socio-familiar del paciente, que jugará un papel importante en la evolución del mismo a medio/largo plazo. Spontaneous intracerebral haematoma (SICH) represents one the most severe subtypes of ictus. However, and despite a high incidence, medical treatment is almost limited to life support and to control intracranial hypertension and indications of surgical treatment are poorly defined. The aim of this paper was to review the evidence supporting surgical evacuation of SICH. Ten clinical trials and five meta-analyses studying the results of surgical treatment on this pathology were found on English literature. These studies considered all together, failed to show a significant benefit of surgical evacuation in patients with SICH considered as a whole. However, a subgroup of these patients has been considered to potentially present a better outcome after surgical treatment. C
Differentiated surgical treatment of patients with hypertensive intracerebral hematomas  [cached]
Mansur Agzamov,Istam Agzamov,Valery Bersnev,Natalia Ivanova
Medical and Health Science Journal , 2011,
Abstract: Hypertensive intracerebral hematoma is one of the most severe forms of cerebrovascular pathology, characterized by high lethality and disability. One of the objectives in providing assistance remains the development of new minimally invasive methods for the removal of hematomas. We have analyzed the results of surgical treatment of 176 patients with intracerebral hematoma. Patients from the 1st group were done open craniotomy. Patients from the 2nd group were performed the external ventricular drainage, also needle aspiration with fibrinolysis. Patients from the 3rd group were performed minimally invasive removal using the original device. Results of treatment were evaluated using Glasgow outcome scale. Lethality was observed in 1st group in 47.8% of cases, in 2nd group in 31.8%, in 3rd group in 29.7%. Minimally invasive technique reduced the postoperative mortality and improved treatment outcomes of patients with intracerebral hematoma.
Early mortality in spontaneous supratentorial intracerebral haemorrhage
Samprón,N.; Mendia,A.; Azkarate,B.; Alberdi,F.; Arrazola,M.; Urculo,E.;
Neurocirugía , 2010, DOI: 10.4321/S1130-14732010000200001
Abstract: background: spontaneous supratentorial intracerebral haemorrhage is a severe, frequent, and poorly understood condition. despite the publication of 12 randomised controlled trials on this subject, the role of surgery remains controversial and no treatment has proved to be effective. we report on a ten year prospective cohort study based on a defined population treated with or without surgery and their outcome in terms of early survival. methods: population based, ten year prospective observational study directed to patients consecutively admitted to the intensive care unit (icu) in a tertiary centre with spontaneous supratentorial intracerebral haemorrhage. patients were distributed in five groups according to the glasgow coma score (gcs) at admission. haemorrhages were classified as deep-seated or superficial. all patient received standard medical care, and additionally surgery if it was found indicated by the duty neurosurgeon. primary endpoint was early mortality defined as dead occurred by any cause during the admission in the icu. findings: during the ten year period, 1.485 patients were admitted to our centre with primary intracerebral haemorrhage. of these, 376 were admitted to the intensive care unit and 285 sustained supratentorial haemorrhages. low gcs was strong predictor of early mortality. despite the larger size of haematomas in patients undergoing surgical evacuation, surgery was associated with lower early mortality in all gcs subgroups. maximal benefit was observed in patient with admission gcs of 4-8. superficial haematomas were operated on more often, and were associated with lower mortality rate than deep-seated cases. conclusions: our findings suggest that craniotomy for haematoma evacuation may reduce early mortality in patients with primary supratentorial intracerebral haemorrhage. surgery seems specially useful in patients with admission gcs between 4 and 8, and in those with superficial haemorrhages.
Treatment of patients with spontaneous intracranial hematomas  [PDF]
Jokovi? M.B.,Radulovi? D.V.,Tasi? G.M.,?urovi? B.M.
Acta Chirurgica Iugoslavica , 2008, DOI: 10.2298/aci0802119j
Abstract: Spontaneous intracerebral haemorrhage is a common cause of stroke especially in the young. The term "spontaneous intracerebral haemorrhage" refers to bleeding without coincident trauma. About 80% of this haemorrhage occur supratentorial in the basal nuclei and they are associated with hypertension. Etiological factors range from congenital vascular malformations (aneurysmas, AVM, cavernomas) to acquired and degenerative vascular and brain conditions. In primary intracerebral hemorrhage arterial hypertension and consequent vascular changes are the major etiological factors. In secondary- nonhypertensive hemorrhage cause may be associated with aneurysms, AVM, tumors, coagulation disorders. Contemporary diagnosis imaging (CT, MRI) and neurological evaluation, allow early diagnosis and effective medical and/or surgical therapy in a majority patients. Without treatment, the risk of mortality and morbidity is high. Medical management involves normalization of blood pressure, reduction of intracranial pressure, control of brain edema and prevention of seizures. In design for operative treatment must be include age of the patient, hematoma size and location, clinical condition, the level of consciousness and patient outcome. The role of surgery remains controversial.
Spontaneous Intracerebral Haemorrhage in a Child  [cached]
Amit Agrawal,Vikram Jeet Singh Dhingra
APSP Journal of Case Reports , 2012,
Abstract: Spontaneous intracerebral haemorrhage (SICH) is a rare occurrence in children, with different aetiological factors, clinical characteristics and prognosis. A 14 year male child had sudden onset of headache associated with multiple vomiting. Magnetic resonance imaging showed deep seated intracerebral haematoma. Haematoma was evacuated successfully and child recovered without deficits. A high index of suspicion is necessary for the diagnosis of spontaneous intracerebral haemorrhage in children.
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