INDICATIONS AND LIMITATIONS FOR CT-GUIDED STEREOTAXIC SURGERY OF HYPERTENSIVE INTRACEREBRAL HEMORRHAGE, BASED ON THE ANALYSIS OF POSTOPERATIVE COMPLICATIONS AND POOR ABILITY OF DAILY LIVING IN 158 CASES

The authors have studied the indications and limitations for computeri zed tomography (CT) -guided stereotaxic surgery (CTGS Surgery) of hype rtensive intracerebral haematomas (ICH), based on the analysis of 158 patients in our institutions. Of 158 patients, 120 had putaminal haemo rrhage, 21 thalamic, 14 subcortical and 3 in other locations. The pati ents ranged in age from 37 to 82 years (average 60). Haematoma volume ranged from 8 to 140 ml (average 43). Eleven patients in the series wo rsened postoperatively because of rebleeding in 6 cases, cerebral infa rction in 2, and unknown causes in the remaining 3 cases. Seven of the 11 patients pre-operatively had untreated hypertension and 3 had mild liver dysfunction without major haemorrhagic tendency. Most postopera tive complications were seen in older patients and in those with sever e neurological deficit or chronic disease. All these cases ended in po or outcome. From our study, we propose three indications for CTGS Surg ery: absolute, aggressive and passive indications. The absolute indica tion is applied to those who would have been operated on by convention al open surgery. The aggressive indication is for those with mild neur ological deficit so that early rehabilitation can be started to regain higher cerebral function. The passive indication is for elderly patie nts and those with severe neurological deficit or chronic disease. Thi s indication must be decided carefully because poor outcome is likely.