Three treatments for moderate hypertensive intracerebral hemorrhage: A comparative therapeusis
10.3969/j.issn.1672-5921.2010.10.004
- Author:
Ping-Bo WEI
1
Author Information
1. Department of Neurosurgery
- Publication Type:Journal Article
- Keywords:
Conservative treatment;
Intracranial hemorrhage, hypertensive;
Surgical procedures;
Treatment outcome
- From:
Chinese Journal of Cerebrovascular Diseases
2010;7(10):519-522
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To compare the therapeutic efficacy of small skull window microsurgery, minimally invasive surgery for crashing and aspirating of hematoma (MISCAH) , and conservative management for moderate hypertensive intracerebral hemorrhage treatment. Methods: A total of 106 consecutive patients with moderate hypertensive intracerebral hemorrhage (hematoma volume 20-40 mL; Glasgow coma scale[GCS] scores 9 - 12) in unilateral basal ganglion regions were selected. They were randomly assigned to small skull window microsurgery group (n = 31), MISCAH group (n = 36), and conservative treatment groups (n = 39). The recurrent rehemorrhage rate, mortality rate, and disability rate 3 months after the procedure were observed. Three patients in the MISCAH group and six patients in the conservative treatment group eventually underwent microsurgery through small skull window for evacuation of hematoma. Results: Circled digit oneThe volume of hematoma evacuated in the small skull window microsurgery group was >75%. Among them, 9 were almost evacuated completely. The volume of hematoma evacuated in the MISCAH group was <50%. Circled digit twoThe recurrent hemorrhage rates in the small skull window microsurgery group, MISCAH group, and conservative treatment group were 6.5% (2/31), 30.3% (10/33), and 45.5% (15/33), respectively. Their mortality rates were 3.2% (1/31), 24.2% (8/33), and 48.5% (16/33), respectively. The disability rates were 35.7% (10/28), 68.0% (17/25), and 73.3% (11/15), respectively. There were significant differences of the recurrent hemorrhage rate, mortality rate, and disability rate between the small skull window microsurgery group and both the MISCAH group and conservative treatment groups(P<0.01, P<0.05). There was no significant significance in the recurrent hemorrhage rate and disability rate between the MISCAH group and the conservative treatment group(P>0.05), except the mortality rate (P < 0.05). Conclusion: Microsurgery through small skull window for evacuation of hematoma is the most safe and effective method for treatment of hypertensive intracerebral hemorrhage. The MISCAH can decrease the mortality rate of the patients, but it can not reduce the recurrent hemorrhage rate and disability rate. The conservative treatment was only suitable for patients with small amount of bleeding, without disturbance of consciousness, and with mild neurological deficits.
