Surgical treatment of patients with hypertensive intracerebral hematomas in the Republic of Tatarstan
https://doi.org/10.17650/1683-3295-2024-26-4-38-46
Abstract
Background. Over time as a result of improved surgical techniques, the emergence of new minimally invasive methods of intracerebral hematoma evacuation and more careful selection of patients potential for surgery, surgical treatment of hypertensive intracerebral hematoma has taken its niche in modern neurosurgery.
Aim. To study the results of surgical treatment of patients with hypertensive intracerebral hematomas in the Republic of Tatarstan.
Materials and methods. The retrospective multi-center study included data from 1127 patients with hypertensive intracerebral hemorrhages from 4 regional and 14 primary vascular centers in the Republic of Tatarstan for 2022, 87 patients were operated.
Results. Among surgical methods the share of the open method was 64,4 %, endoscopic 32,2 %, external ventricular drainage / ventriculoperitoneal shunt implantation 3,4 %. Hospital mortality was 25,3 %. The highest mortality and incidence of recurrent hemorrhages were in patients operated on within the first 8 hours from the onset of symptoms. When comparing comparable groups (in terms of hematoma volume and severity of patients with intracerebral hemorrhage), in the surgical group hospital mortality was 2,9 times lower (22,6 %) than in the conservative group (65,6 %).
Conclusion. Surgical removal of aggressive hypertensive intracerebral hematoma, at a patient’s severity of 8 points and above on the Glasgow coma helps reduce mortality. Endoscopic removal should be more widely used for deep aggressive haematomas. The optimal time to remove aggressive hypertensive intracerebral hematoma is 8 to 24 hours from the onset of a stroke.
Keywords
hypertensive intracerebral hematoma,
hemorrhagic stroke,
surgical treatment of hypertensive intracerebral hematoma
Supporting agencies: The study was performed without external funding
About the Authors
M. M. Yachkurinskikh
Kazan State Medical University
Russian Federation
Russian Federation
Mars Mikhailovich Yachkurinskikh
420012; 49 Butlerova St.; Kazan
V. I. Danilov
Kazan State Medical University
Russian Federation
Russian Federation
420012; 49 Butlerova St.; Kazan
References
1. Mendelow A.D., Gregson B.A., Fernandes H.M. et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet 2005;365(9457):387–97. DOI: 10.1016/S0140-6736(05)17826-X
2. Mendelow A.D., Gregson B.A., Rowan E.N. et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet 2013;382(9890):397–408. DOI: 10.1016/S0140-6736(13)60986-1
3. Mckissock W., Richardson A., Taylor J. Primary intracerebral hemorrhage: a controlled trial of surgical and conservative treatment in 180 unsolicited cases. Lancet 1961;278:221–6. DOI: 10.1016/S0140-6736(61)90353-1
4. Shnyakin P.G., Botov A.V., Rudenko P.G., Bashkov A.A. Results of surgical treatment of hypertensive intracerebral hemorrhages of putamenal localization by open and minimally invasive methods. Sovremennye problemy nauki i obrazovaniya = Modern Problems of Science and Education 2022;2. Available at: https://science-education.ru/ru/article/view?id=31605. (In Russ.). DOI: 10.17513/spno.31605
5. Borovsky A.A., Davidyan A.V., Shamkalovich A.V. et al. Surgical and conservative treatment of patients with non-traumatic intracerebral hematoma: pros and cons. Zhurnal Voprosy Neirokhirurgii im. N.N. Burdenko = Burdenko’s Journal of Neurosurgery 2021;85(3):5361. (In Russ., In Engl.). DOI: 10.17116/neiro20218503153
6. Ryabinkina Yu.V., Gnedovskaya E.V., Maksimova M.Yu. et al. Stroke: incidence and risk factors for venous thromboembolic complications in intensive care unit. Anesteziologiya i reanimatologiya = Anesthesiology and Intensive Care 2015;60(5):54–9. (In Russ.).
7. Krylov V.V., Dashyan V.G., Danilov V.I., Godkov I.M. Surgical treatment of hypertensive intracerebral hematomas (clinical recommendations). Nevrologicheskii zhurnal = Neurological Journal 2016;21(3):146–51. (In Russ.).
8. Shesterikov Y.A., Petrosyan К.G., Pospelov E.N. et al. Results of open and endoscopy-guided removal of hypertensive intracerebral hematomas. Neyrokhirurgiya = Russian Journal of Neurosurgery 2018;20(2):50–7. (In Russ.). DOI: 10.17650/1683-3295-2018-20-2-50-57
9. Krylov V.V., Dashyan V.G., Shetova I.M. et al. Neurosurgical care for patients with cerebrovascular pathology in Russian Federation. Neyrokhirurgiya = Russian Journal of Neurosurgery 2017;(4):11–20. (In Russ.).
10. Godkov I.M. Endoscopic surgery of hemorrhagic stroke. Abstract of dis. … doctor med. sci. Moscow, 2023. 42 p. (In Russ.).
11. Nishihara T., Nagata K., Tanaka S. et al. Newly developed endoscopic instruments for the removal of intracerebral hematoma. Neurocrit Care 2005;2(1):67–74. DOI: 10.1385/NCC:2:1:067
12. Luzzi S., Elia A., Del Maestro M. et al. Indication, timing, and surgical treatment of spontaneous intracerebral hemorrhage : systematic review and proposal of a management algorithm. World Neurosurg 2019;124:e769–e78. DOI: 10.1016/j.wneu.2019.01.016
13. Prokopyev L.V., Dashyan V.G., Petrov S.I. et al. The choice of the timing of surgical treatment of hypertensive intracerebral hematomas by endoscopy. In: Сollection of abstracts: IX All-Russian Congress of Neurosurgeons. 2021. Pp. 279–280. Available at: https://elibrary.ru/item.asp?id=46468370 (accessed 02. 12. 2023).
14. Dashyan V.G., Godkov I.M., Prokopyev L.V. et al. Surgical results for hypertensive intracerebral hemorrhages depending on intervention timing. Annaly klinicheskoy i eksperimental’noy nevrologii = Annals of Clinical and Experimental Neurology 2021;15(4):36–43. DOI: 10.54101/ACEN.2021.4.4
Review
For citations:
Yachkurinskikh M.M., Danilov V.I. Surgical treatment of patients with hypertensive intracerebral hematomas in the Republic of Tatarstan. Russian journal of neurosurgery. 2024;26(4):38-46. (In Russ.) https://doi.org/10.17650/1683-3295-2024-26-4-38-46
Views:
282
Email this article 