Zusammenfassung
Grundlagen: In einer retrospektiven Studie wurden die Krankengeschichten von 210 Patienten mit spontanen intrazerebralen Hämatomen aus den Jahren 1980 bis 1990 untersucht, um das Behandlungsergebnis und die Effizienz der Neuroendoskopie mit der konventionellen Kraniotomie und dem konservativen Vorgehen zu vergleichen. Ausgeschlossen wurden Patienten mit Aneurysmen, arteriovenösen Malformationen, Hirntumoren und Kopfverletzungen.
Methodik: Aufnahmezustand (GCS=Glasgow Coma Scale), Behandlungsmethode, Alter, Hämatomgröße, Lage der Blutung und Ventrikeleinbruch sowie das Behandlungsergebnis (GOS=Glasgow Outcome Scale) nach 6 Monaten wurden miteinander verglichen. Je 70 Patienten fanden Aufnahme in einer der drei Behandlungsgruppen.
Ergebnisse: Prognostisch ungünstig waren ein GCS von 3–6 sowie ein Alter von 65–80 Jahren; des weiteren ist bei einer Hämatomgröße>50 cm3 und einem Ventrikeleinbruch mit einer schlechteren Prognose zu rechnen. Die lobären Blutungen hatten ein besseres Behandlungsergebnis als die tiefen Blutungen (Thalamus, Putamen), während die Behandlungsmethode nur einen tendenziellen Einfluß auf die Lebensqualität ausübte (besserer GOS in der Reihenfolge konservativ — endoskopisch — operativ).
Schlußfolgerungen: Insgesamt zeigte sich ein höheres Mortalitätsrisiko für die konservativ Behandelten gegenüber den endoskopisch und operativ Behandelten, wobei jedoch nur die neurochirurgischen Patienten postoperativ an einer Intensivstation Aufnahme fanden. Frühe Nachblutungen waren in der operativ und besonders in der endoskopisch behandelten Gruppe deutlich häufiger.
Summary
Background: In a retrospective study 210 patients with spontaneous intracerebral haematoma (ICH) admitted between 1980 and 1990 were reviewed with respect to different ways of management (conventional surgical evacuation versus neuro-endoscopic evacuation versus conservative treatment, respectively). Each of the three groups consisted of 70 patients. Patients with aneurysms, arteriovenous malformations, brain tumours and head injuries were excluded.
Methods: Analysis (Glasgow Outcome Scale (GOS) after six months) was based on the following parameters: level of consciousness, Glasgow Coma Scale (GCS), age, location, size of haematoma as well as presence of ventricular haemorrhage.
Results: Factors linked with had prognosis were a low Glasgow Coma Score (3–6), age>65 years, intraventricular haemorrhage and haematomas with volume exceeding 50 cm3. Lobar haematomas had a better outcome than deep haemorrhages. There was no statistically significant advantage with neuroendoscopic treatment compared to conventional ways of management. The lower mortality observed in the neurosurgical groups was not combined with a statistically better functional outcome.
Conclusion: Mortality was higher in the conservative group, however, only neuro-surgically treated patients were monitored at an Intensive Care Unit (ICU). Early rebleeding was more common in neuroendoscopically treated patients than in patients undergoing craniotomy or conservative management. Morbidity was similar in both surgically treated groups.
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Unger, F., Haselsberger, K., Trummer, M. et al. Verschiedene Behandlungsmethoden des spontanen intrazerebralen Hämatoms — Gibt es Vorteile durch eine neuroendoskopische Operation? Eine retrospektive Studie. Acta Chir Austriaca 31, 314–317 (1999). https://doi.org/10.1007/BF02619932
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DOI: https://doi.org/10.1007/BF02619932
Schlüsselwörter
- Spontane intrazerebrale Blutung
- Chirurgie
- Intensivstation (Stroke Unit)
- prognostische Faktoren
- Behandlungsergebnis