The usual accepted surgical treatment for hypertensive intracerebral hemorrhage has been until now craniotomy and hematoma removal. This conventional surgery, performed under general anesthesia, is, however, fairly invasive in nature, especially for elderly patients or patients who have medical risk factors. There has been a long history of debate between surgical and conservative treatment. A less invasive alternative is aspiration surgery. Aspiration surgery can be carried out under local anesthesia, is safe for high-risk patients, and can be indicated for deep-seated hematomas such as thalamic or brain stem hemorrhages. We consider aspiration surgery the choice of surgery for cases with various types of hypertensive brain hemorrhage. We treated the patients by “CT controlled stereotactic aspiration surgery” since 1983. We report the characteristics of our system and surgical procedures in detail.
We use a CT controlled stereotactic operation system (Matsumoto's type) and ultrasonic hematoma aspirator for aspiration surgery. The characteristics of our operation system are as follows. First, the coordinate system of the CT scanner itself is used directly (a localizing frame is not required). Second, we carry out the operation with serial observations of repeat CT scanning to confirm the result of the operation. Third, we can check intraoperatively the trajectory of the aspiration needle, and if any problem occurs, we can easily change the direction of the aspiration needle. The ultrasonic hematoma aspirator is useful in the aspiration of the acute stage hematoma, which is always hard and impossible to sufficiently aspirate by using only negative pressure.
Our surgical procedure is as follows. A burr-hole operation is performed in the operating room to prevent infection or CT scanner contamination by blood or irrigation water. Next, in the CT room, hematoma aspiration is carried out under serial CT observations, and the CT controlled operation system and ultrasonic hematoma aspirator are applied. After hematoma aspiration, a drainage tube is left in the hematoma cavity, through which urokinase is administered to achieve a complete evacuation of residual hematoma postoperatively. We believe our “CT controlled stereotactic operation” has the above-mentioned advantages over conventional surgery or other methods of aspiration surgery. We consider that this surgery facilitates the natural healing process of intracerebral hematomas and will become the standard operation for hypertensive intracerebral hemorrhage.
