Emergency treatment of spontaneous frontotemporal intracerebral hematoma / 中国医师进修杂志

ABSTRACT

Objective To investigate the emergency treatment measures of spontaneous frontotemporal intracerebral hematoma.Methods Retrospectively analyzed the rescue process and surgical experiences of 27 patients with spontaneous frontotemporal intracerebral hematoma combined with subarachnoid hemorrhage or ventricular hemorrhage.Twenty-three cases underwent surgery;4 cases with cerebral hernia under general anesthesia underwent craniotomy hematoma clearance,aneurysm clip and decompressive craniectomy;7 cases with previous history of hypertension,considered with hypertensive intracerebral hemorrhage,was performed with craniotomy hematoma clearance and decompressive craniectomy in the emergency under general anesthesia; 12 cases of middle cerebral artery aneurysms bleeding,chosen craniotomy hematoma clearance and aneurysm clip;4 cases found nothing by digital subtraction angiography (DSA) or CT angiography (CTA),were given conservative treatment,one of them was found arteriovenous malformations after 1 month,which was treated by γ-ray.Results After the surgery,2 cases died due to severe cerebral infarction,25 cases were followed up for 6 months,according to the Glasgow outcome scale(GOS) classification17 cases with good prognosis,7 cases with poor prognosis,1 case with vegetative state.Conclusions Cerebral hernia formation in patients with spontaneous frontotemporal intracerebral hematoma should relieve cerebral hernia and mass effect as soon as possible,early surgery to save lives.Which of them without brain hernia,after diagnosis by CTA or DSA,choice suitable treatment.Sufficient preoperative evaluation,suitable surgical timing and good microsurgical techniques can improve the prognosis.