Surgical treatment of hypertensive intracerebral hemorrhage.

Abstract

D ISEASES affecting the cerebral blood vessels are the most common cause of death in Japan. Approximately 160,000 persons die of these diseases and their complications each year. In recent years, neurosurgeons have displayed an increasing interest in cercbrovascular problems. Much has been written on the surgical treatment of intracranial aneurysms and vascular malformations as well as on endarterectomy and other vascular surgical techniques designed to restore circulation in the carotid and vertebral arterial systems. In contrast, little has been published concerning the surgical treatment of hypertensive intracerebral hemorrhage. We are therefore taking this opportunity to report our encouraging experiences in the diagnosis and surgical t reatment of 43 hypertensive patients with spontaneous intracerebral hematomas treated on our service since 1960. In 1908, Cushing ~ reported his experiences in the management of patients with acute cerebral compression due to intracerebral hemorrhage. Subsequently, there were sporadic reports by other surgeonsT,':,:7, '0 but the results were discouraging. Since 1950, the number has increased to slightly more than 800 reported c a s e s . 1,3,4,6,s-:~ However, no remarkable progress has been made. This is understandable, inasnmch as hypertensive cerebrovascular disease is usually complicated by such problems as senility, generalized arteriosclerosis, myocardial ischemia or infarction, impaired renal function and pulmonary congestion. The surgical attitude toward the hypertensive intracerebral hemorrhage problem has been summed up by McKissock and his asso-