Stereotactic Surgery in the Management of Hypertensive Intracerebral Hemorrhage: Evaluation of the Efficacy Using Continuous Intracranial Pressure Monitoring.

Kim, Jin Young; Cho, Kyung Gi; Ahn, Young Hwan; Ahn, Young Min; Yoon, Soo Hwan; Cho, Ki Hong

Original Article

Journal of Korean Neurosurgical Society 1998;27(11): 1558-1565.

Jin Young Kim, Kyung Gi Cho, Young Hwan Ahn, Young Min Ahn, Soo Hwan Yoon, Ki Hong Cho

Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea.

ABSTRACT

Persistently elevated intracranial pressure(ICP) has been associated with poor clinical outcome after intracerebral hemorrhage(ICH). Increased ICP is one of the main target of treatment in hypertensive ICH. To evaluate the efficacy of stereotactic surgery for the patients with hypertensive ICH, continuous ICP monitoring was done in these patients. This study is based on 30 patients(39-75 years of age, with a mean age of 59.4 years) between January 1996 and December 1997, who had suffered hypertensive supratentorial ICH. All patients underwent partial removal of the hematoma(mean 11.8cc in volume) through the stereotactically placed catheters and the residual hematoma was drained by urokinase irrigation for average of 3.4 days. ICP was monitored in all cases starting before the surgery and continuously until two days after the surgery. Patients were assigned into three categories(Category A; less than 20mmHg, Category B; 20-30mmHg, and Category C; above 30mmHg) according to the initial(preoperative) ICP. Ten patients(39.5cc in average volume of hematoma) were defined to category A, six(45cc) to category B, and fourteen(62.4cc) to category C. After partial removal of the hematoma, there was statistically significant difference in drop of ICP(average 8.4mmHg in category A, 16mmHg in category B, and 36.7mmHg in category C)(p<0.001) and postoperative ICP was maintained under 20mmHg in all patients by urokinase irrigation and external drainage through the stereotactically placed catheters. Cerebral perfusion pressure(CPP) was maintained more than 90mmHg after partial removal of hematoma in all patients. This study demonstrates that ICP was controlled effectively by stereotactic external drainage with intermittent mannitol infusion under the continuous ICP monitoring without large decompressive surgery under general anesthesia for patients whose ICH volume was more than 60cc. Exception to this would be those with rapid progression of neurologic deterioration.

Key Words: Hypertensive intracerebral hematoma; Stereotactic surgery; Continuous intracranial pressure monitering; Cerebral perfusion pressure; Initial intracranial pressure