Abstract
The purpose of the stereotactic aspiration for hypertensive intracerebral hemorrhage is to regain patient's motor function as early as possible, and lead to good outcome. We studied the results of the stereotactic aspiration by comparing the changes in muscle strength of affected extremities before and 1 week after the operation in patients with hypertensive intracerebral hemorrhage. Preoperative neurological grading (NG) and computed tomography (CT) classification were evaluated by the Japanese Ad Hoc Commitee proposed in 1978.
Among various factors such as age, NG, CT classification, hematoma volume, and timing of operation, we selected the important ones which could influence the early postoperative improvement of motor function.
Stereotactic aspiration of hematoma was performed in 65 patients with putaminal hemorrhage (PH), and 43 patients with thalamic hemorrhage (TH). The mean timing of operation was 3.9 days after the onset of hemorrhage, and the mean ratio of aspirated hematoma was 77% (80% for PH and 72% for TH).
The marked improvement of motor function was observed in following cases. (a) Age was less than 70 years old in the case of TH. (b) NG was better than III in PH, and II in TH. (c) CT classification was better than IIIa in PH, and IIa in TH. (d) Volume of hematoma was less than 60 ml in PH, and 20 ml in TH. (e) Timing of the operation was not related to the post-operative results.
Somatosensory evoked potential (SEP) was recorded in 32 patients with PH before and after the operation. The N20 of SEP was recognized pre- and post-operatively, or reappeared post-operatively in 8 of 9 patients who showed marked improvement of motor functions. Cerebral blood flow (CBF) was measured using 123I-IMP SPECT in 8 patients before and after the operation. Increase in CBF was recognized postoperatively in all 3 patients who showed marked improvement of motor function.
