Proceedings of the Xth Meeting of the World Society for Stereotactic and Functional Neurosurgery, Maebashi, Japan, October 1989 Stereotact Funct Neurosurg 1990:54+55:451-452
Evacuation of Hypertensive Intracerebral Hematoma by a Stereotactic Technique Liu Zonghui, Kang Guiquan, Chen Xiaohan, Tian Zengmin, Cai Houzheng, Zhang Yi, Li Shiyu Department of Neurosurgery, Navy General Hospital, Beijing, People's Republic of China Key Words. Hypertensive intracerebral hematoma • Computed tomography guided stereotactic technique • Intracerebral hematoma evacuation Abstract. 30 patients with a hypertensive intracerebral hematoma were treated by stereotactic evacuation between 1986 and 1988. There were 20 males and 10 females; their ages ranged from 37 to 78 years. The time interval from onset to operation was in 16 patients 24 days and in 14 patients 2-7 days. In 19 patients the hematoma was found in the internal capsule, in 5 in the cerebellum, in 4 in the subcortex, and in 2 in the brain stem. The operation was performed with a Leksell computed tomography guided stereo tactic apparatus and a Backlund hematoma evacuator. More than 80% of the hematoma could be aspirated in 20 patients and 60-80% in 10. 29 patients are alive, and I patient died.
Patients and Methods Patients
30 patients with a hypertensive intracerebral hematoma were treated between Janu ary 1986 and December 1988. 20 patients were male, 10 were female. Their ages ranged from 37 to 78 years, with an average of 54 years. The location of the hematoma was in 19 patients in the internal capsule, in 5 in the cerebellum, in 4 in the subcortex, and in 2 in the brain stem. The volumes of the hematoma were calculated by computed tomography (CT) scanning. The volumes of the hematomas on internal capsule subcortex, and cere bellum were 20 to 100 ml; < 10 ml in 2 hematomas of the brain stem. 16 patients were op erated within 24 h after onset, 10 within 2-3 days, and 4 within 4-7 days.
Under local anesthesia the CT-guided stereotactic apparatus was attached to the skull. A burr hole was made in the frontal or parietal region. A single approach was used with the Backlund hematoma evacuator in 23 patients, and double approaches were per© 1990 S. Kargcr AG. Basel 1011-6125/90/0554-0451 S2.75/0
Downloaded by: Thomas Jefferson University Scott Library 147.140.20.32 - 2/8/2018 7:00:16 AM
Operative Technique
Zonghui/Guiquan/Xiaohan/Zengmin/Houzheng/Yi/Shiyu
452
formed in 7 patients. The Backlund hematoma evacuator was a 20 cm long screw drill en closed within a cannula, 4 mm in its outer diameter. At the upper part of the instrument, there is a branching tube for suction. Through a water-/ airtight seal at the top, the screw can be rotated from outside while maintaining a vacuum.
Results More than 80% of hematomas were aspirated in 20 patients and 60-80% in 10. 6,000 U of urokinase was used in 18 patients. Postopera tive complications developed in 2 patients: 1 patient was cured after a second operation, and the other had inhalation pneumonia. The results were good in 9 patients (30%); 10 patients (33%) were mildly and 10 (33%) severely disabled. 1 patient (3.4%) died from heart failure. During the follow-up period (2-24 months), 4 additional pa tients died: due to myocardial infarction in 2, cerebral infarction in 1, and cerebral rebleeding in 1.
Conclusions
Liu Zonghui, MD, Department of Neurosurgery, Navy General Hospital, 6 Fu-Cheng Road, Beijing (People’s Republic of China)
Downloaded by: Thomas Jefferson University Scott Library 147.140.20.32 - 2/8/2018 7:00:16 AM
The authors consider the CT-guided stereotactic technique for evacuation of hypertensive intracerebral hematomas accurate and ef fective. With this method more than 60% of the volume of hematoma can be evacuated, sufficient to improve the patients’ symptoms. The re sidual part of the hematoma was gradually absorbed. This operation is fairly safe, and complications are rare; so it is ideal for the treatment of hypertensive intracerebral hematomas.
Evacuation of Hypertensive Intracerebral Hematoma by a Stereotactic Technique Liu Zonghui, Kang Guiquan, Chen Xiaohan, Tian Zengmin, Cai Houzheng, Zhang Yi, Li Shiyu Department of Neurosurgery, Navy General Hospital, Beijing, People's Republic of China Key Words. Hypertensive intracerebral hematoma • Computed tomography guided stereotactic technique • Intracerebral hematoma evacuation Abstract. 30 patients with a hypertensive intracerebral hematoma were treated by stereotactic evacuation between 1986 and 1988. There were 20 males and 10 females; their ages ranged from 37 to 78 years. The time interval from onset to operation was in 16 patients 24 days and in 14 patients 2-7 days. In 19 patients the hematoma was found in the internal capsule, in 5 in the cerebellum, in 4 in the subcortex, and in 2 in the brain stem. The operation was performed with a Leksell computed tomography guided stereo tactic apparatus and a Backlund hematoma evacuator. More than 80% of the hematoma could be aspirated in 20 patients and 60-80% in 10. 29 patients are alive, and I patient died.
Patients and Methods Patients
30 patients with a hypertensive intracerebral hematoma were treated between Janu ary 1986 and December 1988. 20 patients were male, 10 were female. Their ages ranged from 37 to 78 years, with an average of 54 years. The location of the hematoma was in 19 patients in the internal capsule, in 5 in the cerebellum, in 4 in the subcortex, and in 2 in the brain stem. The volumes of the hematoma were calculated by computed tomography (CT) scanning. The volumes of the hematomas on internal capsule subcortex, and cere bellum were 20 to 100 ml; < 10 ml in 2 hematomas of the brain stem. 16 patients were op erated within 24 h after onset, 10 within 2-3 days, and 4 within 4-7 days.
Under local anesthesia the CT-guided stereotactic apparatus was attached to the skull. A burr hole was made in the frontal or parietal region. A single approach was used with the Backlund hematoma evacuator in 23 patients, and double approaches were per© 1990 S. Kargcr AG. Basel 1011-6125/90/0554-0451 S2.75/0
Downloaded by: Thomas Jefferson University Scott Library 147.140.20.32 - 2/8/2018 7:00:16 AM
Operative Technique
Zonghui/Guiquan/Xiaohan/Zengmin/Houzheng/Yi/Shiyu
452
formed in 7 patients. The Backlund hematoma evacuator was a 20 cm long screw drill en closed within a cannula, 4 mm in its outer diameter. At the upper part of the instrument, there is a branching tube for suction. Through a water-/ airtight seal at the top, the screw can be rotated from outside while maintaining a vacuum.
Results More than 80% of hematomas were aspirated in 20 patients and 60-80% in 10. 6,000 U of urokinase was used in 18 patients. Postopera tive complications developed in 2 patients: 1 patient was cured after a second operation, and the other had inhalation pneumonia. The results were good in 9 patients (30%); 10 patients (33%) were mildly and 10 (33%) severely disabled. 1 patient (3.4%) died from heart failure. During the follow-up period (2-24 months), 4 additional pa tients died: due to myocardial infarction in 2, cerebral infarction in 1, and cerebral rebleeding in 1.
Conclusions
Liu Zonghui, MD, Department of Neurosurgery, Navy General Hospital, 6 Fu-Cheng Road, Beijing (People’s Republic of China)
Downloaded by: Thomas Jefferson University Scott Library 147.140.20.32 - 2/8/2018 7:00:16 AM
The authors consider the CT-guided stereotactic technique for evacuation of hypertensive intracerebral hematomas accurate and ef fective. With this method more than 60% of the volume of hematoma can be evacuated, sufficient to improve the patients’ symptoms. The re sidual part of the hematoma was gradually absorbed. This operation is fairly safe, and complications are rare; so it is ideal for the treatment of hypertensive intracerebral hematomas.
