Expert Care of Patients with Non-Traumatic Intracranial Hemorrhages: Problems of Organization

V.V. Krylov

(Sklifosovsky Research Institute of Emergency care, Moscow)

The goal of the study was to determine organizational principles of surgical treatment of cases with non-traumatic intracranial hemorrhages (NTICH).

An activity of a consulting neurosurgical team, aimed at selection of patients with NTICH, and results of their surgical treatment in the Sklifosovsky Research Institute of Emergency Care were analyzed.

There were 12214 cases with different forms of acute disorders of cerebral circulation, examined in Moscow hospitals during the last 9 years (01.01.1995-31.12.2003); NTICH was diagnosed in 7978 of them (65%); 2648 (33%) of them were treated in the above Institute.

There were 1093 cases, operated for aneurysm rupture. Estimation of risk factors, conditioning aneurysm rupture, resulted in considerable reduction of postoperative mortality from 22% in 1995 up to 8% in 2003. There were 97 patients, operated for ruptures of arteriovenous malformations (1997-2003). Hypertensive intracerebral hematomas were present in 178 cases (1997-2003). Development of surgical technique of stroke treatment reduced postoperative mortality from 50% in 1997 up to 23% in 2003.

Organization of surgical treatment of patients with NTICH is characterized by the following most important aspects:

1. Early admission of cases with NTICH.
2. Creation of expert neurosurgical teams for providing urgent consultations by a neurosurgeon and transfer of cases with NTICH into a neurosurgical department.
3. Organization of twenty-four-hour CT and angiographic service.
4. Organization of specialized operating rooms and neuroresuscitation units.
5. Mastering technique of aneurysm microsurgery.
6. Developing tactics of treatment of cases with NTICH, depending on a character of the disease course.

Organization of activity in the Neurosurgical Department of the Sklifosovsky Research Institute of Emergency Care and its principles can be used as a model for creation of expert neurosurgical centers for treatment of cases with NTICH.