Deep Hypertensive Intracerebral Hemorrhages Complicated by Intraventricular Hemorrhage and Acute Obstructive Hydrocephalus: Little-Invasive Methods of Surgical Treatment

Shirshov ., Dobzhanskiy N, Piradov .

Research Institute of Neurology, Russian Academy of Medical Sciences, Moscow, Russia

 

The research goal was improving conventional methods and developing new ways of surgical treatment of deep hypertensive intracerebral hemorrhages, which would ensure better results in complicated forms of stroke.

Material and Methods. There were 196 cases (80 females and 116 males) with hypertensive intracerebral hemorrhages of subtentorial localization, treated in 1989-2005. A number of operated cases was 117; 86 of them had deep-lying hematomas. Their localization was lateral, mixed and medial. Open little-invasive removal of hematomas (>40 cm3) was performed in 31 cases. Stereotaxic removal was made in 30 patients; the CRW-FN stereosystem (Radionics) was used. Closed external ventricular drainage was applied in 25 cases (medial and mixed hematomas of less than 30 cm3) as an independent procedure. It was auxiliary in 22 cases. Fibrinolytics (urokinase or actilyse) were injected via a ventricular catheter in 6 patients for acceleration of blood lysis in ventricles. Conservative treatment was carried out in 82 cases.

Results and Discussion. Open removal of deep-lying hematomas, complicated by intraventricular hemorrhage and acute obstructive hydrocephalus, was characterized by the mortality rate of 35%. This index in stereotaxic removal and external ventricular drainage was 17% and 27% respectively. As for conservative treatment, the mortality rate was 45%. Remote results were better in cases, subject to surgical treatment (p<0.05).

Conclusion. Little-invasive surgical methods (CT-guided stereotaxic removal of hematomas, long-term ventricular drainage, use of fibrinolytics) are advantageous in deep-lying intracerebral hematomas with intraventricular hemorrhage and acute obstructive hydrocephalus.