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World Journal of Emergency Medicine ›› 2014, Vol. 5 ›› Issue (3): 203-208.doi: 10.5847/wjem.j.issn.1920-8642.2014.03.008

• Original Articles • Previous Articles     Next Articles

Relationship between different surgical methods, hemorrhage position, hemorrhage volume, surgical timing, and treatment outcome of hypertensive intracerebral hemorrhage

Feng-ling Chi1, Tie-cheng Lang2, Shu-jie Sun3(), Xue-jie Tang4, Shu-yuan Xu5, Hong-bo Zheng6, Hui-song Zhao7   

  1. 1Department of Neurosurgery, Shanghai 7th Hospital, Shanghai 200137, China
    2Yueyang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
    3Emergency Medicine Department, Dongfang Hospital of Shanghai, Shanghai, China
    4Second Hospltal of Dalian Medical University, Dlian, China
    5Shanghai Pudong New Area Gongli Hospital, Shanghai, China
    6First People's Hospital of Qiqihaer City, Heilongjiang Province, China
    7Third Affiliated Hospital, Qiqihar Medical College, Heilongjiang Province, China
  • Received:2014-03-03 Online:2014-09-15 Published:2014-09-15
  • Contact: Shu-jie Sun E-mail:sunshujie11@126.com

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Abstract:

BACKGROUND: The present study aimed to explore the relationship between surgical methods, hemorrhage position, hemorrhage volume, surgical timing and treatment outcome of hypertensive intracerebral hemorrhage (HICH).
METHODS: A total of 1 310 patients, who had been admitted to six hospitals from January 2004 to January 2008, were divided into six groups according to different surgical METHODS: craniotomy through bone flap (group A), craniotomy through a small bone window (group B), stereotactic drilling drainage (group C1 and group C2), neuron-endoscopy operation (group D) and external ventricular drainage (group E) in consideration of hemorrhage position, hemorrhage volume and clinical practice. A retrospective analysis was made of surgical timing and curative effect of the surgical methods.
RESULTS: The effectiveness rate of the methods was 74.12% for 1 310 patients after one-month follow-up. In this series, the disability rate was 44.82% 3-6 months after the operation. Among the 1 310 patients, 241 (18.40%) patients died after the operation. If hematoma volume was >80 mL and the operation was performed within 3 hours, the mortality rate of group A was significantly lower than that of groups B, C, D, and E (P<0.05). If hematoma volume was 50-80 mL and the operation was performed within 6-12 hours, the mortality rate of groups B and D was lower than that of groups A, C and E (P<0.05). If hematoma volume was 20-50 mL and the operation was performed within 6-24 hours, the mortality rate of group C was lower than that of groups A, B and D (P<0.05).
CONCLUSIONS: Craniotomy through a bone flap is suitable for patients with a large hematoma and hernia of the brain. Stereotactic drilling drainage is suggested for patients with hematoma volume less than 80 mL. The curative effect of HICH individualized treatment would be improved via the suitable selection of operation time and surgical method according to the position and volume of hemorrhage.

Key words: Hypertensive intracerebral hemorrhage, Hemorrhage position, Hemorrhage volume, Surgical timing, Stereotactic drilling drainage, Treatment effect, Individualized, Polycentric