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Journal of Korean Neurosurgical Society 1988;17(2): 271-282.
A Clinical Analysis of Stereotaxic Evacuation of Hypertensive Intracerebral Hematoma.
Hyung Shik Shin, Sang Sup Chung, Seung Chul Rhim, Kyu Chang Lee
Department of Neurosurgery, College of Medicine, Yonsei University, Seoul, Korea.
Recent trend in the treatment of hypertensive intracerebral hematoma is stereotaxic surgery in preference to conservative treatment or conventional microsurgery. However, the three modalities of therapy have not been comparatively evaluated by objective criteria. Therefore, the authors analyzed 263 patients with hypertensive intracerebral hematoma who received various modes of treatment;54 CT guided stereotaxic evacuation, 73 craniotomy and 136 conserevative treatment. The results were summarized as followings: 1) In medium sized basal ganglia hematomas, the outcome of motor grade and Glagow outcome scale of craniotomy group, and the outcome of mental state, motor grade and Glasgow outcome scale of sterotactic evacuation group was better than that of conservative treatment group. 2) In two surgical groups, the subacute surgery group(24 hrs to 72 hrs) showed the best outcome of mental state but there was no significant difference between the outcomes of motor grade according to the time of surgery. 3) Among three groups, the mortality was the lowest in the stereotaxic evacuation group(9.3%) and highest in conservative treatment group(33.8%). In the patients with intraventricular hemorrhage, the mortality was significantly increas. 4) The stereotasic evacuation can minimize the brain damage and be performed under the local anesthesia. It can substitute the craniotomy or conservative treatment in the treatment of deep seated hematomas such as thalamus and basal ganglia.
Key Words: Hypertensive intracerebral hematoma; Stereotaxic evacuation; Archimedean screw; Urokinase injection
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