Serious Cases of the Hypertensive Intracerebral Ganglionic Hemorrhage

Mortality of the hypertensive intracerebral ganglionic hematoma is still high. One of its reasons is that the treatment of very serious cases is difficult by either conservative therapy or surgical therapy. The purpose of this paper is to seek the possibility to save this very serious case. The results were following; 1) In the past three years since CT was available, 100 cases of intracerebral ganglionic hematoma were treated surgically. Among these cases, 22 serious cases of which CT showed a large volume of hematoma extending even into the ventricles were involved. 2) In these serious cases, the hematoma completed its spread within three hours after the attack which was verified with CT examination. 3) When the hematoma was seen spreading during CT examination, severe vomiting developed along with high blood pressure usually more than 200 mmHg. 4) The serious cases were devided into two sub-groups according to the way of hematoma spreading. The first group should be called “thalamic sparing group” of which the original bleeding point was located in putamen. The second group should be called “thalamic non-sparing group, ” of which the original bleeding point was located in thalamus. The thalamic sparing group did not spread into thalamus even if a large volume of hematoma was noted in all ventricles. Therefore, the so-called “combined type” corresponded to the spreading type of the thalamic hemorrhage, whereas the putaminal hemorrhage did never become the combined type. 5) We applied the following surgical method to treat these serious cases. (1) Insertion of big catheters into the bilateral posterior horns to wash out the clots in ventricles. (2) Removal the main hematoma by the transsylvian fissure approach. (3) Removal of the clots in the fourth ventricle, if necessary. However, by this surgery, only 3 cases in the thalamic sparing group and 2 cases in the thalamic non-sparing group were saved. 6) To improve the operative results, the hematoma removal within three hours after the attack might be recommended. To decrease the number of the serious cases, the hypotension therapy and anti-emetic therapy just at the attack might be useful.