Surgical Outcome of Hypertensive Pontine Hemorrhages: Experience of 13 Cases.
- Author:
Jae Taek HONG
1
;
Seung Jin CHOI
;
Dae Kon KYE
;
Choon Keun PARK
;
Sang Won LEE
;
Joon Ki KANG
Author Information
1. Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Hypertensive pontine hemorrhage;
Hematoma removal;
Early surgery group;
Late surgery group
- MeSH:
Brain;
Glasgow Coma Scale;
Hematoma;
Hemorrhage*;
Humans;
Prognosis;
Tomography, X-Ray Computed
- From:Journal of Korean Neurosurgical Society
1998;27(1):59-65
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Hypertensive pontine hemorrhage usually causes profound, irreversible neurological deficits, with ominous prognosis, and is often fatal. There is controversy as to the appropriate treatment modality, but in general, surgical intervention is considered unethical. The authors report the outcome of hypertensive pontine hemorrhage in 13 patients whose Glasgow Coma Scale was 4-9, who on brain CT scan were seen to have over 10cc of hematoma and who underwent suboccipital craniectomy for hematoma removal. These patients could be divided in two groups: 'early'(9 patients), who underwent surgery within 24 hours of ictus, and 'late'(4 patients), who underwent surgery 6 to 20 days after ictus: all had shown neurological deterioration in spite of optimal medical treatment. Surgical outcome did not vary according to the extent of hematoma removal. For patients in the 'early' group, surgery was not useful, but three in the 'late' group, the GCS score improved to between 7 and 11. This study suggests that in hypertensive pontine hemorrhage, an early direct approach may not improve outcome, but for selected patients, who deteriorate during conservative treatment, surgery may be beneficial.
