Kanno T, Sano H, Shinomiya Y, Katada K, Nagata J, Hoshino M, Mitsuyama F
J Neurosurg. 1984 Dec;61(6):1091-9. doi: 10.3171/jns.1984.61.6.1091.
The indications for surgery in hypertensive intracerebral hematoma are still controversial. The reason for this may be: 1) lack of adequate and comparable data in conservative and surgical therapy from the same institution; 2) lack of adequate close follow-up monitoring over an extended period of time; or 3) lack of proper classification of hematomas for comparison of results from different institutions. The authors have treated 459 cases of hypertensive intracerebral hematoma between October, 1975, and July, 1983. The hematomas have been classified according to their mode of extension on computerized tomography. The long-term outcome was assessed on the basis of activity of daily living. Putaminal hematomas were classified as mild, moderate, severe, and very severe. In general, there was no significant difference in outcome between the surgical and nonsurgical cases; however, the outcome in the moderate and severe hematomas was found to be a little better for the surgical cases in some restricted areas. Thalamic and pontine hemorrhages were classified as mild, moderate, or severe. If the hematoma is localized to the thalamus or pons, and if it extends to the midbrain, there is no indication for surgery; however, in patients with moderate hematomas, the prognosis showed a variable outcome, and the indications for surgery were questionable. In cerebellar hematomas, the authors propose that even a hematoma with a diameter greater than 3 cm might show a good outcome with nonsurgical therapy.
高血压性脑出血的手术指征仍存在争议。其原因可能是：1）同一机构在保守治疗和手术治疗方面缺乏充分且可比的数据；2）缺乏长时间的充分密切随访监测；或3）血肿分类不当，无法比较不同机构的治疗结果。作者在1975年10月至1983年7月期间治疗了459例高血压性脑出血患者。根据计算机断层扫描上血肿的扩展方式进行分类。根据日常生活活动能力评估长期预后。壳核血肿分为轻度、中度、重度和极重度。总体而言，手术病例和非手术病例的预后无显著差异；然而，在某些受限区域，中度和重度血肿的手术病例预后稍好。丘脑和脑桥出血分为轻度、中度或重度。如果血肿局限于丘脑或脑桥，且扩展至中脑，则无手术指征；然而，对于中度血肿患者，预后结果不一，手术指征存疑。在小脑血肿中，作者提出，即使直径大于3 cm的血肿，非手术治疗也可能有良好预后。
