1988 Volume 28 Issue 2 Pages 164-169
The indications for surgery in cases of traumatic intracerebral hematoma (ICH) have not been firmly established. In the past, early operation was the rule, but it frequently entailed acute brain swelling, considerable blood loss during the surgery, and residual hematomas postoperatively. These complications are attributable to the obscurity of the border between the hematoma and the surrounding tissue, the hemorrhagic disposition, and the localized circulatory stasis that are common features of head injury. In this study of nine cases of traumatic ICH, surgery was delayed for 1 week after the injury, during which time conservative treatment was applied. With the conservative therapy there was fairly good recovery of hemostatic function. Then, during surgery, hemostasis was easily accomplished, and blood loss minimized, because the hematoma margins were clearly delineated. With this regimen, seven of the nine patients had improved consciousness and the other two reported alleviation of severe headache. None of the patients developed the complications associated with early surgery. Provided that intracranial pressure is not elevated and clinical signs and symptoms are not deteriorating, delayed surgery appears to be safer and more effective in the management of traumatic ICH.
