title: Transtentorial herniation in patients with hypertensive putaminal haemorrhage is predictive of elevated intracranial pressure following haematoma removal.
abstract: We investigated surgical outcomes of haematoma evacuation in patients with hypertensive putaminal haemorrhage, with emphasis on the development of postoperative refractory intracranial hypertension. Twenty-two consecutive patients with hypertensive putaminal haemorrhage underwent microsurgical clot removal without decompressive craniectomy. Medical histories, radiographic findings, and surgical notes were reviewed. Twenty patients survived to discharge. Twelve patients with preoperative transtentorial herniation, demonstrating a greater haematoma volume and lower Glasgow Coma Scale (GCS) score, had significantly elevated postoperative intracranial pressure. Five of these patients developed refractory intracranial hypertension (42%), and two of these patients died. Conversely, none of the 10 patients without preoperative transtentorial herniation experienced refractory intracranial hypertension, and they had a better outcome at discharge. The preoperative presence of clinical transtentorial herniation may predict the development of postoperative refractory intracranial hypertension, which may require decompressive craniectomy.
authors.affiliation: Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University, 301 Middle Yanchang Road, Zhabei District, Shanghai 200072, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Wang
authors.forename: Yajun
authors.initials: Y
authors.lastname: Xue
authors.forename: Xianzhen
authors.initials: X
authors.lastname: Chen
authors.forename: Daming
authors.initials: D
authors.lastname: Cui
authors.forename: Meiqing
authors.initials: M
authors.lastname: Lou
mesh_terms: D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000009:adverse effects*; D005260:Female; D015600:Glasgow Coma Scale; D006406:Hematoma / Q000150:complications / Q000601:surgery*; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology*; D020146:Putaminal Hemorrhage / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed