[Surgical indication and limitation in hypertensive intracerebral hemorrhage of the basal ganglia].
The purpose of this paper is to elucidate surgical indication and limitation for severe hypertensive intracerebral hemorrhage in the basal ganglia (HIH) with a view toward good functional outcome. Materials were 32 patients of severe basal ganglionic hemorrhage (HIH). Neurological grading (G) for HIH, reported by Kanaya et al. in 1978, was applied. Grading on admission in 11 patients with conservative treatment was G-4a in 2, G-4b in 3 and, G-5 in 6. Preoperative grading in 21 patients with surgical treatment was G-4a in 9, G-4b in 8 and G-5 in 4. G-4a revealed semicoma without herniation signs, G-4b semicoma with herniation signs and G-5 deep coma. The interval from the onset of HIH to hematoma evacuation was from 3 to 10 hours in 14 patients, from 17 to 23 hours in 5, 44 hours in one and 5 days in one. Functional outcomes at hospital discharge were classified as follows: self-managing (SM); partially dependent (PD); fully dependent (FD); vegetative (V); dead (D). Factors which would have influenced functional outcomes were studied and the results follow. All 11 patients with conservative treatment died. On the contrary, in 21 patients with surgical treatment, the outcomes were SM in 2 patients, PD in 3, FD in 11, V in one and D in 4. Death in the 4 patients was caused by fatal complications from 8 to 24 days after the operation. In 17 surviving patients with surgical treatment, (a) Mean age of the SM or PD patients was 45 years, and that of FD or V patients was 55 years.(ABSTRACT TRUNCATED AT 250 WORDS)
D000328:Adult; D000368:Aged; D001480:Basal Ganglia Diseases / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000601:surgery*; D005260:Female; D006406:Hematoma / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged