[Neurosurgical treatment of spontaneous and traumatic intracerebral hematomas].

In the period from 01.01.2000 until 31.12.2002 34 patients with spontaneous intracerebral hematoma (ICH) and with deeply disturbed state of consciousness were operated in the Department of neurosurgery of the Urgent Center, Clinical Center of Serbia. In all operated patients the indication for surgery was given on the basis of CT scan of the brain, state of consciousness, defined Glasgow coma score (GCS) and neurological status, but due to existing or threatening incarceration not even one patient was submitted to angiography of the blood vessels at the cerebral base, thus preoperatively we did not know the cause of the hemorrhage. Of 34 operated patients 22 or 64.7% died, and 12 or 35.3% survived. 14 patients were in the deepest phase of coma, where the preoperative GCS is from 3 to 5 points, and in the postoperative course only one survived, aged 25. The other survivors had somewhat less disturbed state of consciousness, they also were younger, CT scan of the brain was without blood in the chamber system. In the same period, in the Department of Neurosurgery of the Urgent Center, Clinical Center of Serbia 43 patients with traumatic intracerebral hematoma (TIH) were operated; 9 patients survived, 34 died. Only 4 patients had acute TIH. All of them were in the terminal stage of incarceration, and despite being immediately submitted to surgery all of them died. The remaining 39 patients had, the so called delayed TIH where the secondary CT scan of the brain showed development of the traumatic intracerebral haematoma that was not verified on the incipient scanner. Indication for a repeated CT scan was given in 19 patients due to focal or general neurological deterioration. However in 20 patients subsequent neurological disturbances were not registered. Those that survived were younger patients, and they were not in the deepest stage of coma, most often they had a temporal localization of hematoma.

[Neurosurgical treatment of patients with supratentorial cavernoma].

The aim of this study is to present the principal clinical manifestations and neurosurgical results of the treatment of patients with supratentorial cavernoma and epilepsy. The retrospective study included 14 patients with supratentorial lesion on MRI and CT scan of the brain that manifested with epileptic seizures. All patients were surgically treated and pathophysiologic evaluation in all patients confirmed that cavernoma was in question. Results were analyzed and compared with data from the literature. Epileptic seizures are the most frequent clinical manifestation found in supratentorial cavernoma and neurosurgical treatment gives excellent result as regards the control of epilepsy, with a very low incidence of morbidity and mortality. A complete resection of all cavernomas in this study was confirmed by postoperative neurosurgical diagnosing. 12 patients did not have any more epi seizures in the postoperative period, and in 2 patients we found decrease in the occurrence of epilepsy seizures.

[Neurosurgical treatment of spontaneous intracerebral haematomas]. / Neurohrursko lecenje spontanih intracerebralnih hematoma.

There have been 34 patients with spontaneous intracerebral haematomas (ICH) operated, from the 1st January 2002. Yr to the 31st December 2002. Yr., at the Neurosurgical Department of Trauma Centre (Clinical Centre of Serbia). They all were with the serious disturbance of consciousness. For all these patients, indication for operation was established according to CT findings, state of consciousness, defined Glasgow Coma Score (GCS) and neurological state. Due to the established incarceration or its risk, none of these patients had angiography, so preoperatively we didn't know the reason of bleeding. From 34 operated patients, 22 or 64.7% died and 12 or 35.3% survived. There were 14 patients in the deepest state of coma, where preoperatively GCS score was 3 to 5. Only one patient age 25 survived postoperatively. Other survivors have less disturbed state of consciousness, CT findings without intraventricular bleeding and were also in younger age group.

[Neurosurgical treatment of traumatic intracerebral hematoma]. / Neurohirursko lecenje traumatskih intracerebralnih hematoma.

From January 1st to August 31st 2002 yr., Neurosurgical department of the Trauma Center, Clinical Center of Serbia, has operated 43 patients with posttraumatic intracerebral haemathoma (PTIH). From that number, 9 patients survived and 34 died. Only 4 patients with acute PTIH were in terminal state of incarceration and in spite they were operated immediately, all died. Other 39 patients have delayed PTIH where secondary CT cerebral scans showed the development of posttraumatic intracerebral haematoma that has not been verified at the incipient scanner. Indication for repeated CT scan was found for 19 patients for their focal or general neurological deterioration. 20 patients had no delayed neurological disturbances. Survivors were younger, in lower grade of coma and were mostly with temporal localisation of haemathoma.