高血圧性脳出血の外科治療—特に亜急性期について

SURGICAL TREATMENT OF HYPERTENSIVE INTRACEREBRAL HEMORRHAGE IN SUB: ACUTE STAGE

Ｉ．はじめに

　高血圧性脳出血の外科治療については，解決されなければならない多くの問題を含んでいる。特に手術適応に関しては従前から論ぜられているにもかかわらず，いまだ明確な結論を得ていない。

　本論文においては高血圧性脳出血における手術適応の諸問題について若干の考察を試みたい。

Recently, hypertensive intracerebral hemorrhage and its operative treatment are again moving into the forefront of attention. Opinion of neurosurgeons as to the operatory indication of the disease still defer great deal, and the indication has not been established yet. From the therapeutical point of view, it is necessary to draw a sharp line between the therapy of hypertensive intracerebral hemorrhage in acute stage and in sub-acute stage.

In our series, 7 cases with hypertensive intrace-rebral hemorrhage was operated in sub-acute stage.

The operatory criteria are discussed and following conclusion was obtained.

1. Hypertensive intracerebral hemorrhage should be operated in subacute stage because of good op-erative result, the least possible stress on the patient, and the least operative motarity.

2. Cases with putaminal bleeding, in which he-matorna extends forewards, have extremely good operative indication and posterior extension of he-matoma without severe clouding of consciousness have relative operative indication.

3. Improvement of conscious level may be ex-pected by evacuation of hematoma in cases with thalamic or subthalamic bleeding but improvement of hemiplegia is not satisfactory comparing to cases with putaminal bleeding.

A proper evaluation of surgical treatment of hy-pertensive intracerebral hemorrhage in sub-acute stage will require greater experiences and more work on determination of criteria for operative in-dication.