Kobayashi S, Sato A, Kageyama Y, Nakamura H, Watanabe Y, Yamaura A
Department of Neurosurgery, Chiba Emergency Medical Center, Japan.
Neurosurgery. 1994 Feb;34(2):246-50; discussion 250-1.
One hundred and one consecutive patients with hypertensive cerebellar hemorrhage were analyzed to determine the criteria for surgery. New criteria based on the patient's Glasgow Coma Scale score at admission and the maximum diameter of the hematoma, as disclosed by computed tomography, are proposed from a retrospective analysis of 52 earlier cases. The criteria are as follows: 1) patients with Glasgow Coma Scale scores of 14 or 15 and with a hematoma of less than 40 mm in maximum diameter are treated conservatively; 2) for the patients with Glasgow Coma Scale scores of 13 or less at admission or with a hematoma measuring 40 mm or more, hematoma evacuation with decompressive suboccipital craniectomy should be a treatment of choice; and 3) for the patient whose brain stem reflexes are entirely lost with flaccid tetraplegia or whose general condition is poor, intensive therapy is not indicated. The validity of these criteria was tested and confirmed in 49 recent cases.
对101例连续性高血压性小脑出血患者进行分析以确定手术标准。通过对52例早期病例的回顾性分析，提出了基于患者入院时格拉斯哥昏迷量表评分及计算机断层扫描显示的血肿最大直径的新标准。标准如下：1）格拉斯哥昏迷量表评分为14或15分且血肿最大直径小于40mm的患者采用保守治疗；2）入院时格拉斯哥昏迷量表评分为13分及以下或血肿直径达40mm及以上的患者，应选择枕下减压颅骨切除术清除血肿；3）脑干反射完全消失伴弛缓性四肢瘫或一般状况较差的患者，不建议进行强化治疗。这些标准在最近的49例病例中得到了验证和确认。
