Summary
From May 1992 to February 1993, 22 cases of hypertensive putaminal haemorrhage (HPH) treated at our hospital were serially measured with transcranial Doppler (TCD) sonography. Among them, 13 patients underwent surgical intervention (3 stereotaxic surgery and 10 craniotomies), and 9 were conservatively treated. Most of the patients of the two operative groups had larger haematomas and developed clinical and/or neurological deterioration, which was the indication for subsequent surgery. Therefore the groups represent different clinical and physiological entities.
On admission, the peak MCA velocities (Vs) in the surgical group (stereotaxic and craniotomy) were significantly lower than those in the conservative group (mean±S.E.M.∶ 38.33±4.26 and 42.00±2.62 cm/sec vs. 57.22±3.23 cm/sec; p < 0.005, respectively). The surgical group also had significantly lower diastolic (Vd) and mean (Vm) velocities than those of the conservative group (p < 0.001). Rather, the admission pulsatility indices (PI = (Vs-Vd)/Vm) in the surgical group were significantly higher than those of the conservative group (mean±S.E.M.∶ 1.42±0.04 and 1.31±0.09 vs. 0.95±0.01; p < 0.005, respectively). Time course velocity curves reached a peak around the 3rd hospital day in all the 3 groups.
The Glasgow coma scale (GCS) scores positively correlated with the mean MCA velocities (n = 22; r = 0.63, p < 0.005; y = 2.04 x + 8.74), but negatively with PI values on admission (n = 22; r = −0.53, p < 0.05; y = 1.68−0.053 x).
On the 7th hospital day, 2 patients with peak MCA velocities below 50 cm/sec had an unfavourable outcome. All the 3 patients in the stereotaxic group had higher peripheral resistance, as compared with those in conservative craniotomy groups (mean±S.E.M.∶ 1.28±0.13 vs. 0.99±0.07 and 0.87±0.06; p < 0.05, respectively).
Our study supports TCD as a safe and valid monitoring method in patients with HPH. “Compromised cerebral haemodynamic status” (Vs < 50 cm/sec, Vd < 15 cm/sec, Vm < 25 cm/sec, PI > 1.15) may offer an aid in the decision for surgical intervention in HPH. Postoperatively, patients who made a favourable recovery had a significant increment in the MCA velocities in contrast to those severely disabled, whose MCA velocities remained low.
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References
Aaslid R, Markwalder TM, Nornes H (1982) Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg 57: 769–774
Auer LM, Deinsberger W, Niederkorn K, Gell G, Kleinert R, Schneider G, Holzer P, Bone G, Mokry M, Korner E, Kleinert G, Hanusch S (1989) Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. J Neurosurg 61: 530–535
Chan KH, Dearden NM, Miller JD (1992) The significance of posttraumatic increase in cerebral blood flow velocity: a transcranial Doppler ultrasound study. Neurosurgery 30: 697–700
Fujitsu K, Muramoto M, Ikeda Y, Inada Y, Kim I, Kuwabara T (1990) Indications for surgical treatment of putaminal hemorrhage. J Neurosurg 75: 518–525
Grosset DG, Straiton J, McDonald I, Cockburn M, Bullock R (1993) Use of transcranial Doppler sonography to predict development of a delayed ischemic deficit after subarachnoid hemorrhage. J Neurosurg 78: 183–187
Hassler W, Steinmetz H, Gawlowski J (1988) Transcranial Doppler ultrasonography in raised intracranial pressure and in intracranial circulatory arrest. J Neurosurg 68: 745–751
Hokama M, Tanizaki Y, Mastuo K, Hongo K, Kobayashi S (1993) Indications and limitations for CT-guided stereotaxic surgery of hypertensive intracerebral haemorrhage, based on the analysis of postoperative complications and poor ability of daily living in 158 cases. Acta Neurochir (Wien) 125: 27–33
Juvela S, Heiskanen O, Poranen A, Valtonen S, Kuurne T, Kaste M, Troupp H (1989) The treatment of spontaneous intracerebral hemorrhage: a prospective randomized trial of surgical and conservative treatment. J Neurosurg 70: 755–758
Kaneko M, Koba T, Yokoyama T (1977) Early surgical treatment for hypertensive intracerebral hemorrhage. J Neurosurg 46: 579–583
Kingman TA, Mendelow AD, Graham DI, Teasdale GM (1987) Experimental intracerebral mass: time-related effects on local cerebral blood flow. J Neurosurg 67: 732–738
Lindegaard KF, Nornes H, Bakke SJ, Sorteberg W, Nakstad P (1988) Cerebral vasospasm after subarachnoid haemorrhage investigated by means of transcranial Doppler ultrasound. Acta Neurochir [Suppl] 42: 81–84
Lindegaard KF, Nornes H, Bakke SJ, Sorteberg W, Nakstad P (1989) Cerebral vasospasm diagnosis by means of angiography and blood velocity measurements. Acta Neurochir (Wien) 100: 12–24
Lindegaard KF, Lundar T, Wiberg J, Sjoberg D, Aaslid R, Hornes H (1987) Variation in middle cerebral artery blood flow investigated with noninvasive transcranial blood velocity measurement. Stroke 18: 1025–1030
Mosdal C, Jensen G, Sommer W, Lester J (1986) Spontaneous intracerebral haematomas. Clinical and computertomographic findings and long-term outcome after surgical treatment. Acta Neurochir (Wien) 83: 92–98
Nath FP, Jenkins A, Mendelow AD, Graham DI, Teasdale GM (1986) Early hemodynamic changes in experimental intracerebral hemorrhage. J Neurosurg 65: 697–703
Nath FP, Nicholls, Fraser RJA (1983) Prognosis in intracerebral haemorrhage. Acta Neurochir (Wien) 67: 29–35
Paillas JE, Alliez B (1973) Surgical treatment of spontaneous intracerebral hemorrhage: immediate and long-term results in 250 cases. J Neurosurg 39: 145–151
Seiler RW (1992) Subarachnoid hemorrhage and vasospasm. In: Newell DW, Aaslid R (eds) Transcranial Doppler. Raven, New York, pp 101–107
Sekhar LN, Wechsler LR, Yonas H, Luyokx K, Obrist W (1988) Value or transcranial Doppler examination in the diagnosis of cerebral vasospasm after subarachnoid hemorrhage. Neurosurgery 22: 813–821
Shang MQ, Yu JP, Wang UD (1990) Changes of regional cerebral flow in patients with intracerebral hemorrhage by 133 xenon inhalation method. Chung-Hua Nei Ko Tsa Chin 29: 491–493 [Chinese]
Sinar EJ, Mendelow AD, Graham DI, Teasdale GM (1987) Experimental intracerebral hemorrhage: effect of a temporary mass lesion. J Neurosurg 66: 568–576
Sloan MA (1993) Detection of vasospasm following subarachnoid hemorrhage. In: Babikian VL, Wechsler LR (eds) Transcranial Doppler ultrasonography. Mosby, St. Louis, pp 105–127
Steiger HJ, Aaslid R, Stooss R, Seiler RW (1994) Transcranial Doppler monitoring in head injury: relations between type of injury, flow velocities, vasoreactivity, and outcome. Neurosurgery 34: 79–86
Tanizaki Y (1988) Improvement of cerebral blood flow following stereotaxic surgery in patients with putaminal haemorrhage. Acta Neurochir (Wien) 90: 103–110
Tedeschi G, Bernini FP, Cerillo A (1975) Indications for surgical treatment of intracerebral hemorrhage. J Neurosurg 43: 590–595
Waga S, Miyazaki M, Okada M, Tochio H, Matsushima S, Tanaka Y (1986) Hypertensive putaminal hemorrhage: analysis of 182 patients. Surg Neurol 26: 159–166
Waga S, Yamamoto Y (1983) Hypertensive putaminal hemorrhage: treatment and results. Is surgical treatment superior to conservative one? Stroke 14: 480–485
Weber M, Grolimund P, Seiler RW (1990) Evaluation of posttraumatic cerebral blood flow velocities by transcranial Doppler ultrasonography. Neurosurgery 27: 106–112
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Lee, E.J., Chio, C.C., Lin, H.J. et al. Application of transcranial Doppler sonography in surgical aspects of hypertensive putaminal haemorrhage. Acta neurochir 138, 60–67 (1996). https://doi.org/10.1007/BF01411726
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DOI: https://doi.org/10.1007/BF01411726