1979 Volume 6 Issue 4 Pages 403-408
In this symposium, I would like to show the actual clinical statistics of two major pathologies, intracerebral hemorrhage and cerebral infarction which are closely related to the arterio- and arteriolosclerotic change in the brain and bring forward two problems in the field of neurosurgical clinic; one regarding to the mechanism of hematoma formation in intracerebral hemorrhage and another concerning to the STA-MCA anastomosis for cerebral infarction.
Since 5 years ago, we admitted 600 cases of cerebro-vascular disease in our hospital which included 137 cases of the lateral type of intracerebral hematoma. As our principle, we admitted all these cases as early as possible after the attack and operated them in the peracute stage or within 7 hours after the attack if it is indicated. In order to elucidate the mechanism of hematoma formation, we took the biopsy specimen from the tip of ruptured lenticulo-striate artery at operation in these cases and examined microscopically and electron-microscopically under the cooperation of professor Takebayashi who is supposed to give an address after me. From the statistics of the lateral type of intracerebral hematoma, a quarter of them was the severe type which showed disturbance of consciousness of more than semicoma and marked hemiplegia on admission. A half of them was the moderate type namely they showed disturbance of conciousness of stupor and apparent hemiplegia on admission. The rest of a quarter was the mild type of mild disturbance of consciousness. By the examination of computerized tomography, the severe type was proved to have larger hematoma than the moderate type. And the mild type showed the smallest hematoma.
This difference of the size of hematoma seemed to be caused mainly by the size of ruptured lenticulo-striate artery. In the early craniotomy for these cases, the bleeding source could be clearly identified; Lenticulo-striate artery was usually ruptured not at its trunk but at its branch of the caliber of approximately 150-200μ. Bleeding source was mostly single and the hemorrhage could be controlled by its single hemostasis.
Pathological findings of these ruptured arteries will be stated by Prof. Takebayashi later. Anyhow, from the above findings, we concluded that intracerebral hematoma is as a rule, caused by the rupture of a single branch of the lenticulo-striate artery and is accomplished by the arterial bleeding mostly within 3 hours after the apoplectic attack.
At the last, I discussed shortly on the problem of STA-MCA anastomosis which is a bypass operation between the superficial temporal artery and the middle cerebral artery in the case of cerebral thrombosis.
