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Stereotactic Treatment of Spontaneous Intracerebral Haemorrhage

Stereotactic Treatment of Spontaneous Intracerebral Haemorrhage. K. Máca, T. Svoboda, P. Fadrus,. Department of Neurosurgery University Hospital Brno. Spontaneous intracerebral haemorrhage /SICH/ is a haematoma within a brain parenchyma, and accounts for approximately 10% of strokes.

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Stereotactic Treatment of Spontaneous Intracerebral Haemorrhage

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  1. Stereotactic Treatment of Spontaneous Intracerebral Haemorrhage K. Máca, T. Svoboda, P. Fadrus, Department of NeurosurgeryUniversity Hospital Brno

  2. Spontaneous intracerebral haemorrhage /SICH/ is a haematoma within a brain parenchyma, and accounts for approximately 10% of strokes.

  3. SICH - approx. 12-15 cases per 100 000 /yearSICH : SAH 2 : 1Significant increase after the age of 55 years

  4. Etiology • Hypertension • Vascular anomalies • AVM • Aneurysm - saccular, microaneurysms / Charcot-Bouchard / • Venous angioma

  5. Etiology • Coagulopathy • CNC infection • Acutely increased CBF – to ischemic areas • Etc. ( sinus tromb.,drug abuse, eclampsia, postoperative stat.)

  6. Evaluation • CT • DSA

  7. MRI • NOT the procedure of choice for initial study

  8. Treatment • Conservative • Surgery STICH - Surgical Trial in Intracerbral Haemorrhage Newcastle Upon Tyne, UK, 1998 - present

  9. Conservative treatment • Minimally symptomatic lesions /GCS 10/ • Little chance of good outcome (massive haemorrhage, poor neurol. condition) • Severe coagulopathy • Elderly patients /75 yrs/

  10. Surgical treatment • Symptomatic lesions • Marked mass effect, oedema, midline shift • Moderate clot volume /10 – 30 ccm/ • Persistent elevated ICP • Rapid deterioration • Young patient /50 yrs/

  11. Cerebellar haemorrhage • GCS14 and haematoma  4 cm diameter Conservatively • GCS 13  4 cm Surgical evacuation Patients with absent brain stem reflexes – intensive therapy is not indicated

  12. CT cerebellum haemorrhage

  13. Surgical treatment • Craniotomy • Stereotactic evacuation • (Endoscopy)

  14. Material • 113 pacients with supra and infratentorial spontaneous haematoma • period 1999 - 2000 • Male : 60% • Female : 40% • mean age: 61 years

  15. Localisation of haematoma supratentorial infratentorial

  16. Localisation of haematoma • Putamen 54 % • Thalamus 12 % • Cerebellum 11 % • Subcortical 23 %

  17. Operation 47,5 ml (20-75 ml)

  18. Period from SICH to craniotomy

  19. Period from SICH to stereotaxy

  20. Anaesthesia - stereotaxy

  21. Stereotaxy • frame - based stereotaxy • Riechert - Mundinger´s stereotactic system or Simple stereotactic device with CT localisation • transcutaneous approach • negative-pressure evacuation of haematoma

  22. Drainage of haematoma

  23. Riechert - Mundinger

  24. Riechert - Mundinger

  25. Simple stereotactic device

  26. Simple stereotactic device

  27. Simple stereotactic device

  28. Complications - stereotaxy • recurrent parenchymal haemorrhage 7 % • infection 0 % • epidural haemorrhage 1 %

  29. GOS ( 6 months ) • good recovery 22 % • moderate disability 36 % • severe disability 24 % • vegetative state 1% • death 17 %

  30. Conclusions Stereotaxy • stereotaxy is a first choice method in patients indicated for evacuation of spontaneous intracerebral haematoma • as a minimally invasive method, it reduced a risk of complications related to craniotomy and reduced the strain of patients • most interventions are performed in local anaesthesia

  31. Conclusions Craniotomy • Is indicated in patients with rapid neurological deterioration, with developing or existing herniation • Is indicated after unsuccessful stereoaspiration

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