[Postoperative intracranial pressure in severe cases with hypertensive intracerebral hematoma].
The relationship between the postoperative ICP and the size of hematoma on CT scan and the time of operation was studied to evaluate their influence on the therapeutic results in the severe cases with hypertensive intracerebral hematoma. Twenty one patients of putaminal hemorrhage with severe neurological deficit (semicoma) were studied. ICP was monitored continuously by the Subdural balloon method after craniotomy to remove the hematoma. The relationship between the postoperative ICP level (High ICP: above 40 mmHg, Moderate ICP: 40-20 mmHg, Low ICP: below 20 mmHg), the size of hematoma estimated from CTscan (Large: more than 80 ml, Medium: less than 80 ml), the time from onset to removing hematoma and the therapeutic results were evaluated. The outcome six months after onset was determined according to the Glasgow Outcome Scale. Of 6 cases with Medium hematoma operated on within 8 hours, Low ICP was found in 5 cases (83%) and Moderate ICP was in one case (17%). Of 6 cases with Medium hematoma operated on after 8 hours, High and Moderate ICP were found in 3 cases (50%), respectively. In the cases with Large hematoma, Low ICP was not observed, but High ICP was found in 4 of 7 cases operated on within 8 hours (57.1%) and the other three indicated Moderate ICP (42.9%). High ICP was found in two cases with Large hematoma operated on after 8 hours (100%). The outcome of High ICP cases was severe disability in 4 cases, vegetative state in one and dead in 4, and that of Moderate ICP cases was moderate disability in 3 cases and severe disability in 4.(ABSTRACT TRUNCATED AT 250 WORDS)
Nakayama
K
K
Department of Neurosurgery and Emergency and Critical Care Medicine Kitasato University, School of Medicine, Kanagawa, Japan.
Miyasaka
Y
Y
Sato
K
K
Ichikawa
F
F
Oka
H
H
Yamaguchi
A
A
Ohwada
T
T
Yada
K
K
D000328:Adult; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D006973:Hypertension / Q000150:complications*; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011184:Postoperative Period; D011379:Prognosis; D014057:Tomography, X-Ray Computed