Abstract
The surgical treatment of hypertensive intracerebral hemorrhage has received little attention since Mckissock et al. reported that surgery is of limited value. But Japanese neurosurgeon's experience with surgical treatment in recent years suggests that clot removal is rational in patients with large hematoma arising from putamen. It is important, however, to evaluate the quality of survival as serious morbidity is equal to an operative mortality.
Since the introduction of CT, 31 patients were disgnoses as having large hematoma which arised from the putamen and perforated into the ventricle. Of 31 patients, 6 went into coma rapidly and all died. Five patients had emergency surgery in the early phase of the disease, i. e. within 6 hours of the onset, because the level of consciousness was deteriorating and 4 patients was survived following surgery. Twelve patients underwent surgery after 6 hours of the onset and all survived the ictus except one. Eight patients were managed medically and all died except one.
We would conclude, therefore, that clot removal is rational therapeutic measure to salvage those patients who have large hematoma perforating into ventricle and who are not comatose at the time of surgery.
Of our 17 surgically treated patients, 10 recovered sufficiently to enjoy their daily lives but 4 were severely disabled. These 4 patients were over 60 years old with dominant hemispherical lesion or had the hematoma extended to the thalamus.
By the introduction of CT, site and extent of hematoma are now diagnosable in a short time. Early surgery should be indicated to the patients with large hematoma considering above mentioned factors which affect the functional recovery.
