抄録
To determine the usefulness of performing ultra-early surgery to treat massive hypertensive intracerebral hemorrhage (ICH), we evaluated 52 patients, aged 49 to 79 years, over a 6-year period. Among them, 35 patients were classified as Group Va, and the remaining 17 cases were grouped as Vb (Kanaya's classification). All patients underwent microsurgical treatment within an average of 4.2 hours after the onset of hemorrhage.
Thirty (Va: 17/35, Vb: 13/17) out of the 52 patients required an emergent tracheal intubation due to respiratory failure when admitted, and a tracheostomy was needed in 13 patients within 1 month after the operation. However, after 6 months, only 3 patients continuously required a tracheostomy. Ventriculostomy was performed in 30 patients (Va: 13/35, Vb: 17/17), and a ventriculo-peritoneal shunt was required in 27 out of the 30 patients (Va: 10/13, Vb: 17/17). Three months after the operation, a Barthel Index above 40 points was found in 27 cases (Va: 16/35, Vb: 11/17), and 50% of patients showing good outcome kept a Barthel Index above 40 at a 6-year follow-up. During the follow-up period, only 3 patients suffered from other medical complications and died within 1 month after the operation.
Our results suggest that decrease of early mortality rate and maintenance of good long-term functional outcomes can be achieved by ultra-early surgery. Ultra-early treatment of respiratory failure and intensive control of the intracranial pressure by a ventriculostomy in the peri-operative period also improve the long-term outcome for patients with massive ICH. Moreover, a meticulous follow-up in the outpatient department is essential.
