고혈압성 뇌실질내혈종의 뇌정위적제거술에 대한 결과 분석

Abstract

The ultimate purpose of treatment in hypertensive intracerebral hematoma(HICH) is effective evacuation of the hematoma with minimal damage to normal brain tissue and prevention of increasing intracranial pressure and progression of an ICH into neighbouring tissue. According to this viewpoint, stereotactic surgery in patients of HICH is recent trend for its safety and precision. An analysis of 50 consecutive patients from Jun. 1988 to Mar. 1989 undergoing stereotactic surgery with urkinase irrigation in HICH was performed. We excluded the HICH below 15cc of volume, poor clinical grade as coma with herniation sign, intraventricular hemorrhages only, infratentorial hematoma and atypical spontaneous intracerebral hematomas as angiographically verified aneurysms, AVM and Moyamoya diseases. Procedures were accomplished utilizing the CT-guided BRW stereotactic frame, then urokinase irrigation was done every 6 hours through a stereotactically inserted catheter until a sufficient volume was drained, and then the patient was checked by a follow-up CT scan. The results were analysed as follows: The incidence was highest in 6th decade with male predominence(62%). Mean dose of urokinase was 6000 IU ×18.73(4.6 days). The statistical analysis of the factors affecting outcome showed that initial neurological grading was highly significant (P<0.001); volume of hematoma was significant also (p<0.05). Associated intraventricular hemorrhage especially ventricular tamponade in HICH was highly poor prognostic factor. Overall good result was 54% and mortality rate was 12% All computations were performed by means of the commonly used SPSS statistical package.