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
M. Hokama et al., 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, Acta neurochirurgica, 125(1-4), 1993, pp. 27-33
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.