Main complications at treatment of nontraumatic intracerebral hematomas of brain hemispheres

Abstract

Objective: to identify clinically significant complications.Materials and methods. Surgical treatment using different methods was performed in 116 patients with nontraumatic intracerebral hematomas; conservative treatment was performed in 100 patients.Results. The overall mortality at surgical treatment was 19.8% (at transcortical approach — 29%, trans- and parasilvial — 25%, after stereotactic removal — 7.1%), at conservative treatment — 19%.Causes of death: a) hemorrhage with brain stem inclination (after surgery — 65.2%, conservative treatment — 73.4%); b) thromboembolism (after surgery — 26%, conservative treatment — 15.8%); c) pneumonia (after surgery — 8.7%, conservative treatment — 10.5%); d) re-bleeding in the bed of the removed hematoma — 4.3%.Main clinically significant complications were identified: a) intra- and postoperative (marked brain edema, new bleeding in the cavity of removed hematoma, bacterial meningitis after ventricular drainage), somatic (thromboembolism, thrombophlebitis, pneumonia, septic condition), neurological (pain and spastic syndromes).Conclusions. The most significant cause of death is dislocation and impaction of the brain stem that necessitates further improve of operative techniques, including implementation of fasting-reclinating interventions. The second direction for complications incidence reducing and functional outcome improving is to optimize drug therapy, including widespread use of antioxidants, especially in comatose patients.