Evaluation of Surgical Treatment for Cerebral Amyloid Angiopathy

Autor:	Iwao Takeshita, Masaru Ohta, Ken Samoto
Rok vydání:	2007
Předmět:	Intracerebral hemorrhage medicine.medical_specialty Subarachnoid hemorrhage business.industry medicine.medical_treatment Glasgow Coma Scale Autopsy medicine.disease Surgery Hematoma Modified Rankin Scale Medicine Cerebral amyloid angiopathy business Craniotomy
Zdroj:	Surgery for Cerebral Stroke. 35:107-112
ISSN:	1880-4683 0914-5508
Popis:	Treatment of cerebral hemorrhage in the elderly is often difficult and a growing concern due to Japan's aging population. We retrospectively evaluated radiological images of intracerebral hemorrhages associated with cerebral amyloid angiopathy (CAA) and surgical efficacy for performance status of patients. From January 2000 to December 2005, 240 patients with intracerebral hemorrhage and 49 patients with cerebral subcortical hemorrhage were reported. Of these, 41 cases fulfilled the Boston criteria for CAA. Diagnosis by autopsy was 0, surgical biopsy histopathology 9, multiple hemorrhagic lesions 8 and single lesion in 24 patients. Involved lobes were frontal: 6, temporal: 1, fronto-parietal: 3, temporo-parietal: 8, parietal: 12, parieto-occipital: 6 and occipital: 5. CAA-related subcortical hemorrhages were commonly distributed in 2 lobes, with the parietal lobe the most commonly affected area. Radiological characteristics of CAA-related subcortical hemorrhages were irregular borders: 30/41 (73%) intraventricular ruptures: 15/41 (37%), and subarachnoid hemorrhage and/or acute subdural hematoma: 37/41 (90%). Surgery was indicated if consciousness level (Japan Coma Scale) was greater than II-20 and hematoma volume greater than 40 ml. Craniotomy was performed on 18 patients with modified Rankin Scale (mRS) with 60% improving postoperatively and the remainder maintaining the same mRS as before surgery. Two patients underwent emergency craniotomy due to a rapidly growing hematoma producing a comatose state. Of the 18 surgical cases, 1 had further bleeding in a different area postoperatively at 3 months. Of the 23 nonsurgical cases, 4 had further bleeding after conservative treatment at 1.5 to 3.5 months with 1 case affected on 3 separate occasions. Surgical removal of hematomas caused by CAA is safe and unlikely to accelerate the rate of further bleeding, but rather contribute to improvement of mRS in selected patients.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_________::5a30ccbd892d25dccc401c90b458aa92 https://doi.org/10.2335/scs.35.107 Zobrazit plný text záznamu