The purpose of this report is to clarify the timing of surgery for removal of intracerebral hematoma.
Sixty-four cases of putaminal hemorrhage were made an object of this study. But a case of postoperative reaccumulation of ICH, a woman of 87 years of age, and a case of a physically handicapped were excluded. Investigation was performed from both clinical and theoretical sides.
According to the print out data of CT findings, hematoma is changeable within 3 hours, then becomes stable between 3 and 6 hours. Perifocal edema appears after 6 hours and becomes the maximum between 3 days and a week. Therefore, the timing of surgery is theoretically within 3 hours which means before enlargement of the hematoma, within 6 hours which means before the appearance of the perifocal edema, and within 3 days which means before the maximum of the edema.
Clinically the limit of the timing of surgery is different depending on the size of the hematoma. Considering about conscious level, when the patient is in somnolence, surgery should be done within 2 days. If the patient in stupor, surgery should be performed within 11 hours. If the patient is in semicoma, surgery should be performed within 6 hours.
Considering the size of the hematoma by CT (see later report No.40: CT grading of lateral type of ICH). Surgery should be performed within 2 days in the case of grade III. The timing of surgery is within 6 hours in the case of grade IV. In the case of grade V, it is difficult to save life, but hematoma can increase from grade III to grade V within 3 hours, so that the only way to save the patient of grade V is to prevent increasing the hematoma within 3 hours.
Comparing between theoretical and clinical and clinical data, the timing of the surgery is within 3 hours for grade V, which means before enlargement of the hematoma, within 6 hours for grade IV or semicoma and stupor, which means before appearance of the perifocal edema, and within 2 days for grade III or somnolence, which means before the maximum of edema.
