Treatment of Hypertensive Intracerebral Hemorrhages: A Choice of Tactics

Zorin N., Dzyak L., Plyuschev I.

Dnepropetrovsk State Medical Academy, Dnepropetrovsk, Ukraine

 

Introduction. A choice of an adequate method for treatment of hypertensive intracerebral hemorrhages (HIH) is the most complicated problem of angioneurosurgery.

The research goal was to determine the most reliable criteria for choosing an adequate method of treatment.

Material and Methods. There were 823 cases with HIH, treated in the regional hospital in 1995-2005. Operations were performed in 453 cases; the rest patients were treated conservatively. Biochemical and neurophysiologic examinations, as well as neurovisualization were carried out in all the cases. A prognostic value of all the results was calculated mathematically.

Results and Discussion. We failed to find any sign with a reliable effect on a course and outcome. It was only a combination of the most important signs, which allowed to make a prognosis. All the cases were divided into 4 single-type groups. A choice of treatment was most difficult in patients with lateral hematomas of 40-100 ml (50% of cases); 60% of them had “aggressive” hematomas, demanding early surgical treatment. It was expedient to perform delayed operations in the rest 40% of cases with “non-aggressive” hematomas. Indications for removal of hematomas with a volume of more than 200 ml and mixed localization should be limited. Before 1998 a choice of treatment was dependent only on a hematoma volume without taking into consideration other indices. At that time the rates of total and postoperative mortality were 43.6% and 42% respectively. Surgical activity was 41.6%. Later treatment tactics was chosen in compliance with indications, developed by us. It resulted in reduction of the rate of total (31.1%) and postoperative (23.2%) mortality. Surgical activity increased up to 56.9%.

Conclusion. Thus, an individual approach to a choice of treatment tactics, based on taking into account all main objective criteria, allowed to improve results of HIH treatment against a background of single-type technique of surgical intervention.