Experience of surgical treatment of patients with acute cerebrovascular diseases under conditons of a city multi-field hospital

Saribekyan A.S., Ponomaryov V.A., Polyakova L.N., Romen V.A., Kondrashin I.I., Oganesyan K.G., Senchukov S.V.

(Neurosurgical Department of the City Clinical Hospital N 15)

A number of patients with craniocerebral diseases, operated in the City Clinical Hospital N 15 during March 1998-August 2000, was equal to 205. There were 155 cases with hemorrhagic stroke, 40 cases with arterial aneurysm ruptures, 10 patients with AVM. Diagnosis was based on results of CT, MRI examinations and serial cerebral angiography. As for patients, 15% and 45% of them were delivered to the above hospital by an emergency team and a visiting neurosurgical team respectively; 10 % of cases were transferred from neurologic departments of other municipal hospitals; 10, 66 and 79 out of 155 patients with hemorrhagic stroke were in a comatous state, a soporific state and topor respectively. Distribution of hematomas was as follows: lateral type - 90 cases, a mixed type - 32 cases, a medial type - 26 cases. Hematomas of the brain stem and cerebellum were watched in 1 and 6 cases respectively. As for degrees of state severity (according to Hunt-Hess), watched in 40 patients with arterial aneurysms, they were represented in the following way: II - 16 cases, III- 19 cases, IV - 3 cases, V - 2 cases. Intracranial hematomas were diagnosed in 23 patients with arterial aneurysms and 6 cases with AVM. Carotid-cavernous anastomosis was observed in 1 patient. Hematomas were removed with the help of three methods: a) open removal with use of a microscope or magnifier - 83 cases; b) puncture aspiration and local fibrinolysis with prourokinase - 64 cases; c) endoscopic removal - 8 patients.

The results were as follows:

  1. Hemorrhagic stroke: mortality - 27%; severe invalidism - 2%; moderate invalidism - 43%; good restoration - 25%; excellent outcome - 3%.
  2. Arterial aneurysms: mortality - 17.5%; severe invalidism - 5%; good and excellent results - 77.5%.
  3. AVM: fatal outcome - 2 cases; good results - the rest cases.