[Models of neurosurgical service for patients with hemorrhagic stroke].

Authors have conducted an analysis of surgical treatment of patients with hemorrhagic stroke (HS) in Moscow neurosurgical in-patient clinics. In 2 most advanced neurosurgical departments out of 11 studied, only 61% of necessary neurosurgical care is carried out. There are three models of specialized neurosurgical care for patients with HS in large cities. The most effective is a model which comprises a mobile consulting neurosurgical team for selection of patients for surgery and their transport. The causes of insufficient amount of surgical interventions in neurosurgical in-patient clinics are specified. The authors suggest the algorithm of HS patients' selection for surgery.

[Diagnostic and treatment of hypertensive cerebellar hematomas].

Authors analyzed the results of treatment of 56 patients with hypertensive cerebellar hemorrhages (volume 0,5-41 cm3). Brain stem symptoms were found in 45 (80%) of patients. The dislocation of brain stem was observed in 38 (68%) cases, occlusive hydrocephaly - in 22 (39%), intraventricular hemorrhage - in 26 (46%). Severity of state depended on character of disease course, presence of stem symptoms, awakening level, volume and localization of cerebellar hematoma, development of intraventricular hemorrhage, occlusive hydrocephaly and dislocation of brain stem. Thirty-six patients were operated. After the neurosurgical intervention, 22 (61%) patients were discharged without or with the minimal neurological deficit, 1 (3%) with marked disability and 13 (36%) patients died. In conclusion, the removal of hematoma is recommended in dislocation of brain stem and disturbance of consiousnes: the ventricular drainage - in occlusive hydrocephaly developed as a consequence of hemotamponade of IV ventricular. The surgical treatment is not recommended to patients with cerebellar hematomas with the volume less than 7 cm3.