Ultra-Early Evacuation of Intracerebral Spontaneous Hematomas

Introduction: The thrombolysis project enables patients to reach emergency departments within the first hour after a cerebrovascular event that is in 20-35% caused by intracerebral hematoma (ICH). Early diagnosis of ICH thus allows for ultra-early evacuation. Objective: Open microsurgery via transylvian approach and precise coagulation of bleeding sources to minimize secondary bleeding with rapid and complete decompression all types of hematoma brings positive effect on secondary brain tissue injury (hypoperfusion, metabolic changes and intracranial hypertension). Ultra-early evacuation of ICH is based on the hypothesis that the undamaged brain tissue is temporarily able to compensate for the negative changes caused by the bleeding. Methods: Prospective study with 2.5 years of follow up of ICH patients with data collection and final evaluation at least 6 month after stroke. The inclusion criteria: spontaneous hypertonic putaminal ICH, MR or CT scan, volume >= 30 ml, GCS >= 8, the time to surgery <= 5-8 hrs., treatment in neurosurgical ICU with multimodality monitoring (with invasive ICP and PBTO2). Results: Follow-up of 17 patients (F: M 2 :15, age 60.6), mean time to surgery 3.8 hours, ICH volume of 73 ml (30-130 ml), mRS 3.5 and GOS 2.9 after six months. Six patients died and six reached favorable results. Volume was the most limiting factor; results were poor in the >= 100 ml group. Conclusion: The indication of surgery is still controversial. Open microsurgery is the method of choice in the ultra-early evacuation and coagulation of the primary source of bleeding is the prevention of rebleeding. Clinically significant independence is expected in patients with the initial volume of 30-80 ml and GCS >= 8 after stroke only.