Surgical treatment of primary intracerebral hemorrhage- Part 1: new angiographical classification

A new angiographical classification of primary intracerebral hemorrhage is presented. We have clarified the predilection sites of intracerebral hemorrhage and the advancing direction of the hematoma by studying autopsy cases. Furthermore, we tried to detect the presence or absence of destruction of the internal capsule and ventricular rupture by means of angiography. Our classification, introducing the idea of dynamic changes of hematoma advancement from localized to advanced type, can be applied to clinical practice. This classification, along with the patient's level of consciousness, it felt to be the most important indication for operation.

[Communicating hydrocephalus following the rupture of intracranial aneurysm (author's transl)]

It is well recognized that the communicating hydrocephalus following the rupture of intracranial aneurysms is one of the factors which cause the disturbance of consciousness in acute stage and the impairment of mental functions in chronic stage. In this report we analyzed the surgical experience with this complication and discussed the mechanisms which cause the ventricular dilatation. 1. The communicating hydrocephalus following the rupture of intracranial aneurysms is devided into the acute form and the chronic form. 2. Acute communicating hydrocephalus may develop with 24 hours after the onset and the incidence is about 10% (6 out of 66 cases). 3. Intraventicular pressure is high in acute communicating hydrocephalus and becomes normal in chronic stage. 4. The incidence of the chronic communicating hydrocephalus is about 10% (6 out of 66 cases). 5. There are two types of chronic communicating hydrocephalus. One develops from acute form and another develops gradually after onset. Among 6 chronic communicating hydrocephalus, 3 developed from acute form, 2 showed slowly progressive ventricular dilatation and 1 admitted with hydrocephalus at chronic stage resepctively. 6. The intraventricular pressure of the acute form is high and the chronic form shows high pressure in acute stage, intermittent high pressure wave lasting 20-30 minutes in subacute stage and normal pressure in chronic stage when the ventricle is dilated. 7. The mechanisms of ventricular dilatation in normal pressure hydrocephalus are discussed on the basis of the continuous monitoring of intraventricular pressure in cases with rupture of intracranial aneurysm. 8. Indication of shunting procedures whould be determined by combination of clinical pictures, ventriculocranial index, findings of cisternography and EEG. Our operative criteria are presented.

[Surgical experience of aged patients with ruptured intracranial aneurysms (author's transl)]

Outcome of 77 cases with ruptured intracranial aneurysms above 60 years of age was reported. 44 cases were treated conservatively and 33 cases surgically. 1. Among conservatively treated group, 10 cases died after initial hemorrhage and 14 cases after second hemorrhage. The mortality rate was 55%. 2. Among surgically treated group, 11 cases died and 4 cases had severe neurological deficits following the direct intracranial operation. The mortality and morbidity rate was 33% and 12% respectively. 3. These results indicate that the direct intracranial operation should be the first choice of treatment to the aged patients also. 4. Intracranial complications occured more frequently than the extracranial one during intra and postoperative course. Among them normal pressure hydrocephalus was the comonnest. 5. Occlusion of the main cerebral artery occured in 5 cases related to operative procedure. Outcome of 4 cases of them was poor. Microsurgical technique should be used in order to prevent these conditions which tend to occur in aged patients.

Arteriographically visualized extravasation in hypertensive intracerebral hemorrhage. Report of seven cases

Seven cases are reported in which extravasation of contrast medium from the lateral lenticulostriate artery was observed on cerebral angiography performed in the early stage of hypertensive intracerebral hemorrhage.

We advance the theory that continuous bleeding from the ruptured artery with mechanical destruction and displacement of cerebral tissue is the cause of massive hematoma formation, and discuss the possibility of surgical treatment of the acute stage of hypertensive intracerebral hemorrhage.

Bypass anomaly of the vertebral artery associated with cerebral aneurysm and arteriovenous malformation

✓ In a series of 1107 patients with cerebrovascular disease studied by four-vessel angiography, the authors have found 10 cases of a bypass anomaly of the vertebral artery. Six of the cases also had cerebral aneurysms, and two cerebral arteriovenous malformations. The authors discuss the possible origins for this relationship.