Peresedov V V
Neurosurgery Clinic, Institute of Neurology, Russian Academy of Medical Sciences, Moscow, Russia.
Comput Aided Surg. 1999;4(1):51-63; discussion 50. doi: 10.1002/(SICI)1097-0150(1999)4:1<51::AID-IGS7>3.0.CO;2-U.
The present study targets the problem of the surgical approach to treatment of intracranial hematomas. We examined a total of 242 patients with clinically evident spontaneous nontraumatic intracerebral hematomas. The majority of patients (79%) were treated in the acute phase of stroke. The patients underwent one of the following treatments: (a) In 731 patients, the hematomas were removed following craniotomy and cortiectomy performed under direct visualization, with a mortality rate of 42.5%; (b) in 64 patients, the hematomas were evacuated stereotactically, with a mortality rate of 21.9%; (c) in four patients, only ventricular drainage was used; and (d) 101 patients were treated with routine nonsurgical methods (comprising the pharmaceutical or conservative group), with a mortality rate of 49.5%. The overall mortality rate was 40%. In 43 patients, a special balloon was implanted into the hematoma cavity after evacuation to prevent recurrent bleeding. Although the first part of this work is now finished, further study of the dynamics of hemorrhage and additional results are needed prior to making a decision on how to divide patient management into the two categories of surgical and nonsurgical treatment.
本研究针对颅内血肿治疗的手术入路问题。我们共检查了242例临床上有明显自发性非创伤性脑内血肿的患者。大多数患者（79%）在中风急性期接受治疗。患者接受了以下治疗之一：（a）731例患者在直视下进行开颅和皮质切除术后清除血肿，死亡率为42.5%；（b）64例患者采用立体定向血肿排空术，死亡率为21.9%；（c）4例患者仅采用脑室引流；（d）101例患者采用常规非手术方法治疗（包括药物治疗或保守治疗组），死亡率为49.5%。总死亡率为40%。43例患者在血肿排空后在血肿腔内植入特殊球囊以防止再出血。虽然这项工作的第一部分现已完成，但在决定如何将患者管理分为手术和非手术治疗两类之前，还需要进一步研究出血动态和其他结果。
