Abstract
We have given up aggresive treatment of intraventricular casting hematoma with midbrain or brain stem symptoms because of poor result of such treatment. When the cause of the moribund state is mainly the compression of the brain stem by casting hematoma rather than brain stem damage, removal of all casting hematoma should be performed in acute stage, as far as possible. Seven moribund patients with coma, decerebrating posture, negative pupil reflex and central respiratory disturbance (CNH) were operated on to remove these casting hematoma, using a supratentorial and subtetorial approach. The primary focus of bleeding was the thalamus in four patients and the cerebellum in three. Supratentorial removal was by frontal transcortical or transcallosal approach. A two stage operation was performed in two cases and a one stage operation in five. The time from onset to operation was 2~12 hours (1~4 hours after midbrain symptom). The outcome was good in five cases but two patients suffered brain stem death. ABR monitoring was performed in three cases: one pre-post follow-up and two post-operative monitoring. ABR will be valuable in the near future.
The indications for operation are 1). Miner brain damage and massive ventricular hematoma, 2). possibility of decompression within eight hours. 3). the symptom will be better than the level of lower brain stem symptom. 4). no midbrain or brain stem damage on CT.
