Supratentorial Сerebral hemorrhage: Pathophysiologic Criteria and Tactics of Treatment

Abstract

Hemorrhagic stroke (HS) constitutes 20 % of acute disorders of cerebral circulation. The incidence of HS in different regions varies between 10 and 35 per 100 thousand population. In spite of modern breakthroughs in neurosurgery and neurology cerebral hemorrhages are characteristic of high lethality and invalidization. Lethality level depends on the size of the hematoma. The lethal outcome is more probable in case of hematoma size over 100 cubic centimeters. The survival rate in patients with larger hematomas may increase provided the conventional surgical treatment is as early as possible before the development of pronounces dislocational manifestations. Hematomas over 80 cubic centimeters case death irrespective of the treatment method due to a combination of large size of hematoma and fast development of intracranial hypertension and dislocation syndrome. Lobar hematomas develop in a more benignant manner while mixed ones may be classified prognostically unfavorable: the lethality in this group is considerably higher than in in other hematomas. The lethality and gravity of clinical manifestations in case of medial hematomas is associated with haigh frequency of intraventricular hemorrhages. Considerable variability of hypertension hematomas’ treatment results testifies to an absence of a common approach to surgical treatment. Surgical treatment may demonstrate its convincing advantages only in case of strict approach to selection of patients for surgery which requires an integral scale for the assessment of the patients’ state. Taking into consideration the high demand for surgical treatment of cerebral hematomas in Russian Federation (about 11 000 operations per year) organization measures are necessary to create additional neurosurgical departments for emergency surgical aid for HS patients.