Takeuchi Satoru, Takasato Yoshio, Masaoka Hiroyuki, Hayakawa Takanori, Yatsushige Hiroshi, Shigeta Keigo, Nagatani Kimihiro, Otani Naoki, Nawashiro Hiroshi, Shima Katsuji
Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
Acta Neurochir Suppl. 2013;118:277-9. doi: 10.1007/978-3-7091-1434-6_53.
Hemispheric hypertensive intracerebral hemorrhage (ICH) has a high mortality rate. Decompressive craniectomy (DC) has generally been used for the treatment of severe traumatic brain injury, aneurysmal subarachnoid hemorrhage, and hemispheric cerebral infarction. However, the effect of DC on hemispheric hypertensive ICH is not well understood. To investigate the effects of DC for treating hemispheric hypertensive ICH, we retrospectively reviewed the clinical and radiological findings of 21 patients who underwent DC for hemispheric hypertensive ICH. Eleven of the patients were male and 10 were female, with an age range of 22-75 years (mean, 56.6 years). Their preoperative Glasgow Coma Scale scores ranged from 3 to 13 (mean, 6.9). The hematoma volumes ranged from 33.4 to 98.1 mL (mean, 74.2 mL), and the hematoma locations were the basal ganglia in 10 patients and the subcortex in 11 patients. Intraventricular extensions were observed in 11 patients. With regard to the complications after DC, postoperative hydrocephalus developed in ten patients, and meningitis was observed in three patients. Six patients had favorable outcomes and 15 had poor outcomes. The mortality rate was 10 %. A statistical analysis showed that the GCS score at admission was significantly higher in the favorable outcome group than that in the poor outcome group (P = 0.029). Our results suggest that DC with hematoma evacuation might be a useful surgical procedure for selected patients with large hemispheric hypertensive ICH.
半球型高血压性脑出血（ICH）死亡率很高。去骨瓣减压术（DC）通常用于治疗重度创伤性脑损伤、动脉瘤性蛛网膜下腔出血和半球型脑梗死。然而，DC对半球型高血压性ICH的疗效尚不清楚。为了研究DC治疗半球型高血压性ICH的效果，我们回顾性分析了21例行DC治疗半球型高血压性ICH患者的临床和影像学资料。患者中男性11例，女性10例，年龄22 - 75岁（平均56.6岁）。术前格拉斯哥昏迷量表评分3 - 13分（平均6.9分）。血肿体积33.4 - 98.1 mL（平均74.2 mL），血肿位于基底节区10例，皮质下11例。11例患者有脑室扩展。关于DC术后并发症，10例患者发生术后脑积水，3例患者发生脑膜炎。6例患者预后良好，15例患者预后不良。死亡率为10%。统计学分析显示，预后良好组入院时的格拉斯哥昏迷量表评分显著高于预后不良组（P = 0.029）。我们的结果表明，对于部分大体积半球型高血压性ICH患者，DC联合血肿清除术可能是一种有效的手术方法。
