Since 1978, the authors have performed stereotactic evacuation in about 300 cases of hypertensive intracerebral hemorrhage using Komai's CT-stereotactic apparatus. We experienced 24 cases of hypertensive pontine hemorrhage from 1979 to 1986; 10 cases treated surgically by sterotactic approach (surgical group, 1983~1986) and 14 treated non-surgically (non-surgical group, 1979~1986). The present paper reports our experience with ten patients with pontine hemorrhage treated by the stereotactic aspiration using Komai's CT-stereotactic apparatus. The paper also tries to evaluate the usefulness of our surgical procedure, comparing the CT findings and the outcome between the two groups.
Our stereotactic aspiration procedure is simple and can be done safely under local anesthesia without any complications. Approximately 83.6% of the hematoma volume was evacuated and the disturbed consciousness and respiration of most of the patients improved in the early postoperative days.
The most important factor affecting the outcome of the treatment was the transverse diameter of the hematoma. With hematomas of 22 to 30mm in diameter, the surgical group exceeded the nonsurgical group in recovery (p<0.05). With hematomas of less than 22mm and those of more than 30mm in diameter, there was no statistical difference in the outcome between the two groups. Concerning the location of the hematoma, the patients with unilateral type hematomas resulted in a good outcome in the surgical group (p<0.05). Those with the bilateral type of hematoma revealed poor outcome in both groups.
We, therefore, conclude that the stereotactic approcch is recommended for a patient with the unilateral pontine hemorrhage whose diameter is 22 to 30mm.