혼미이하의 의식수준을 보이는 자발성 뇌실질출혈 환자에서의 수술 후 결과 = Surgical Outcome of Spontaneous Supratentorial Intracranial Hemorrhage in Less Than Stuporous Mental Status

다국어 초록 (Multilingual Abstract)

Objective : Spontaneous supratentorial intracerebral hemorrhage can be considered as one of the most common
forms of cerebravascular disease. Effective reduction of intracranial volume buffering capacity in elevated
intracranial pressure is most important factor related to a poor prognosis in cases with huge hematoma and
compromised mental status. The role of surgery in the management of such cases are still controversial.
Methods : Thirty patients with altered mental status less than stuporous and spontaneous supratentorial hematoma
were underwent craniotomy or decompressive craniectomy and duroplasty. The hematoma volume were ranging
from 31 to 120ml. In 14 patients, in whom a progression in secondary brain swelling was expected to occur after
hematoma evacuation, a decompressive craniectomy with dural enlargement was performed. The overall clinical
result was expressed as 30 day mortality, Glasgow outcome scale(GOS) and modified Rankin scale 1 year after
surgery. The favorable outcome (GOS 4) were analyzed with variables [age, initial Glasgow coma scale(GCS),
hematoma volume, location of hematoma, extent of midline shift, intraventricular hemorrhage, and time interval
from ictus to surgery].
Results : The overall clinical results showed 10% of 0-day mortality, 56.6% of favorable outcome and 53.3% of
independency ( 2 of modified Rankin scale). A significant statistical correlation was found between outcome and
initial GCS and location of hematoma(p<0.05). The decompressive craniectomy and duroplasty proved some useful
in increasing postoperative GCS of compromised patients.
Conclusion : Surgical treatment of patients with spontaneous supratentorial intracerebral hemorrhage with altered
mentality less than stuporous can have a positive role, in selected cases.