Usefulness of Stereotactic Aspiration Surgery to the Cerebral Hemorrhage : Sequential Change of Cerebral Blood Flow and Neurology after Cerebral Hemorrhage

In observing the sequential change of cerebral blood flow (CBF) of 44 patients with hypertensive intracerebral hemorrhage, we have studied the relation of CBF, treatment, and neurology. Of those 44 patients, 26 had a putaminal hemorrohage, and 18 had a thalamic hemorrhage. A stereotactic aspiration surgery was performed on 9 patients with putaminal hemorrhage and on 7 patients with thalamic hemorrhage. The patients for our study were selected by using the following criteria: (a) no history of cerebrovascular or cardiopulmonary diseases, (b) a neurological grading (Kanaya 1978) between 1 and 3, (c) a hematoma volume less than 45 ml, and (d) under the age of 70. Mean cerebral hemisphere blood flow was measured with ^I-IMP SPECT with arterial blood drawing within 1 week, 2 weeks, 4 weeks, 8 weeks, and then 6 months after the onset, respectively. Those patients whose neurological condition did not improve during the first week after the onset were operated on with stereotactic aspiration surgery. The results of the sequential change of CBF were as follows: Bilateral CBF in the non-operated group of putaminal hemorrhage was reduced from 0 week to 2 weeks, and from 4 weeks to 8 weeks after the onset. It then showed a tendency to increase from 8 weeks to 6 months. Bilateral CBF in the operated group of putaminal hemorrhage was low at the onset. With a temporary increase after the operation, the bilateral CBF decreased from 2 weeks to 4 weeks after the onset. It then showed a tendency to increase from 4 weeks to 6 months. Bilateral CBF both in the operated and non-operated groups of thalamic hemorrhage was low at the onset. It then increased from 2 weeks to 4 weeks, but showed a tendency to decrease from 4 weeks to 6 months. With regards to the putaminal hemorrhage, it was found that the initial neurological grading correlates with CBF value. Aspiration surgery was effective in recovering hemiparesis of those patients with putaminal hemorrhage whose initial CBF value was low and whose posterior limb of the internal capsule was not impaired. With the thalamic hemorrhage, neurological grading was found to correlate, not with CBF value, but with hematoma volume. Compared with the putaminal hemorrhage, reduction of CBF stayed chronic, and aspiration surgery was not effective for the thalamic hemorrhage.