Neurosurgical aspects of hemorrhagic stroke

Introduction. The occurrence of hemorrhagic stroke (HS) is about 1/5 of that of ischemic stroke, but HS represents an important problem of neurology because of high mortality and disability rates. HS can manifest as spontaneous subarachnoid hemorrhage (SAH), intracerebral hematoma (ICH), spontaneous (non-traumatic) extradural and subdural hematomas, or as a combination of these conditions. HS is characterized by a high percentage of complications, most severe of which is intraventricular hemorrhage (IVH).

Objective. To analyze the structure of HS, its complications and various methods of neurosurgical treatment.

Materials and methods. We studied medical histories of 84 patients with HS were who were treated in the Neurosurgical Department of GBUZ RB Hospital ambulance Ufa for the 6-month period in 2016. All patients underwent neurological, instrumental and laboratory examination, CT scan and CT angiography, brain MRI and, if necessary, cerebral angiography (CAG). To assess the severity and outcome of IVH, we used the Graeb criteria of the ventricular system involvement and the Hounsfieid characteristics of the ventricular clot density.

Results. The main causes of HS were arterial hypertension (54,7%) and aneurysmal disease of the brain (44%). Most of patients (63,8%) had putaminal ICH. Rupture of the aneurysm was the cause of SAH in 24 (28.6%) of patients. Aneurysms were located mostly in the basin of the middle cerebral artery. Surgical treatment was undertaken in 76 patients (90.4%t). IVH as a complication occurred in 21.4% of patients, main cause of this complication was massive SAH.

Discussion. In most of our cases of HS, the clinical picture of SAH was seen – 59.5% of patients. Among all methods of neurosurgical treatment of ICH, we predominantly used minimally invasive high-tech techniques proven to be most effective: needle aspiration, endoscopic removal of hematomas under the control of neuronavigation, and fibrinolysis; these technologies were used in 52.5% of patients.