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
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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.
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