Optimal Times of Carrying Out of Operative Treatment of Patients with Hypertensive Hemorrhagic Stroke
Clinical Neurology and Neuroscience
Volume 3, Issue 4, December 2019, Pages: 77-83
Received: Oct. 1, 2019;
Accepted: Oct. 29, 2019;
Published: Nov. 4, 2019
Views 54 Downloads 11
Mitalip Mamytov, Department of Neurosurgery, Kyrgyz State Medical Academy, Kyrgyzstan, Bishkek
Keneshbek Yrysov, Department of Neurosurgery, Kyrgyz State Medical Academy, Kyrgyzstan, Bishkek
Background: Until now, nobody has arrived at a general consensus on the timing of operative treatment intervention, depending on the hemorrhage nature, localization and volume and the severity of patient's condition. Objective: To assess the results of operative treatment of patients with hypertension-induced hemorrhagic stroke (HS) in order to determine the optimal times of surgical interventions, thereby improving the results of operative treatment. Methods: The treatment outcome analysis has been performed regarding the patients with hypertensive hemorrhagic stroke (HHS), who underwent surgery operation at the neurosurgery and neurotraumatology departments of the National Hospital of the MH KR. The age of patients ranged from 43 to 76 years. The main etiological factor in all cases was hypertensive disease. Results: The mean age of postoperative patients was 60 years old (the youngest patient was 43 years old and the oldest was 76 years old). Out of the 90 (100%) postoperative patients 74 (82.2%) patients were discharged with improvement, and 16 (17.8%) patients with fatal outcome. And also the fatality rate analysis has been performed depending on the HHS volume and the midline structure dislocation degree. Among the deceased postoperative patients, the distribution by HHS volume was as follows: up to 60 cm3 - 11.5% of cases, from 61 to 80 cm3 - 9.52%, from 81 to 120 cm3 - 22.58% and above 121 cm3 - 33.3%. The deceased patient distribution by the midline structure dislocation degree was as follows: up to 2 mm - in 11.1% of cases, from 3 to 6 mm - in 21%, over 10 mm - in 40%. Also the fatality rate analysis has been performed, depending on the timing of operative treatment. Among the deceased postoperative patients, the distribution by operative treatment times was as follows: 1–3 days 23.7% of cases, 4–6 days 16.6%, 7–9 days 12.5%, 10 days and more - 11.1% (Table 6). Conclusions: The prognostic favorable times for operative treatment of patients having HHS with different localization and volumes (60 cm3-80 cm3), and with different dislocations of midlinebrain structures (from 2 to more than 6 mm) range from 3 days to 15-20 days. And the surgery operation is unjustified for the patients with supratentorial localization of than 120 cm3 in volume with midline structure dislocation of more than 10 mm, and in this case the watchful waiting must be applied.
Optimal Times of Carrying Out of Operative Treatment of Patients with Hypertensive Hemorrhagic Stroke, Clinical Neurology and Neuroscience.
Vol. 3, No. 4,
2019, pp. 77-83.
10 primary causes of death in the world: WHO information bulletin. 2014. No. 310. URL: http://www.who.int/mediacentre/factsheets/fs310/ru (reference date: 08.03.2016 г.).
Dzhindzhikhadze RS, Dreval ON, Lazarev VA. Decompressive craniotomy at intracranial hypertension. M: GEOTAR-Media; 2014, 112.
Krylov VV, Dashyan VG,. Burov SA. Hemorrhagic stroke surgery. M: Medicine; 2012.
Mendelow AD, Gregson BA, Fernandes HM. STICH investigators. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trail in Intracerebral Haemorrhage (STICH): a randomised trial, Lancet, 2005; 365, 387-397.
Mendelow AD, Gregson BA, Rowan EN. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial, Lancet, 2013; 382, 397-408.
Akhmadiev RN, Banashkevich VE, Totorkulov RI. Experience in application of puncture aspiration removal of non-traumatic intracerebral hematomas in combination with local fibrinolysis, Pacific Medical Journal, 2012; 4, 90-92.
Svistov DV, Manukovsky VA, Volk DA. Results of surgical treatment of patients with primary intracerebral hemorrhage, Neurosurgery, 2010; 2, 26-33.
Smeyanovich AF, Tanin AL, Golovko AM. Early results of surgical treatment of hypertensive intracerebral hemorrhage, Russian Neurosurgical Journal, 2014; 4, 122-123.
Filippov AI, Shcherbinin AV, Zadorozhny AA. The results of surgical treatment of hypertensive intracranial hemorrhage at the Saint Petersburg Research Institute of Emergency Medicine named after I. I. Dzhanelidze, Russian Neurosurgical Journal, 2014; 4, 128.
King JT Jr, Berlin JA, Flamm ES. Morbidity and mortality from elective surgery for asymptomatic, unruptured, intracranial aneurysms: A meta-analysis. J Neurosurg, 1994; 81, 837-42.
Zhu H, Wang Z, Shi W. Keyhole endoscopic hematoma evacuation in patients. Turk Neurosurg, 2012; 22 (3), 294-299.
Abdu E, Hanley DF, Newell DW. Minimally invasive treatment for intracerebral hemorrhage. Neurosurg Focus, 2012; 32 (4), 1-7.
Krylov VV, Dash'yan VG, Burov SA, Petrikov SS. Surgery Hemorrhagic Stroke. Moscow: Meditsina: 2012.
Takeuchi S, Wada K, Nagatani K, Otani N, Mori K. Decompressive hemicraniectomy for spontaneous intracerebral hemorrhage. Neurosurg Focus, 2013; 34, E5.
Li Q, Yang CH, Xu JG, Li H, You C. Surgical treatment for large spontaneous basal ganglia hemorrhage: retrospective analysis of 253 cases. Br J Neurosurg, 2013; 27 (5), 617–621.
Zheng J, Li H, Zhao HX, Guo R, Lin S, Dong W et al. Surgery for patients with spontaneous deep supratentorial intracerebral hemorrhage: A retrospective case-control study using propensity score matching. Medicine (Baltimore), 2016; 95, e3024.
de Oliveira Manoel AL, Goffi A, Zampieri FG, Turkel-Parrella D, Duggal A, Marotta TR et al. The critical care management of spontaneous intracranial hemorrhage: A contemporary review. Crit Care, 2016; 20, 272.
Krylov VA, Dash'yan VG, Danilov VA, Godkov IM. Surgical treatment of hypertensive intracerebral hematomas. Neurology journal, 2016; 3, 146-151.
Moussa WM, Khedr W. Decompressive craniectomy and expansive duraplasty with evacuation of hypertensive intracerebral hematoma, a randomized controlled trial. Neurosurg Rev, 2017; 40, 115-127.