Tratamento cirúrgico da hemorragia cerebral: considerações a propósito de 11 casos

Pereira, Walter C.; Godoy, Roberto; Ferreira, Celso

doi:10.1590/S0004-282X1977000100002

Resumos

Após breves comentários sobre os achados angiográficos em 298 doentes com acidente vascular cerebral isquêmico ou hemorrágico, é realçada a importância da angiografia cerebral como o método ideal de diagnóstico, tendo em vista a variedade de fatores fisiopatogênicos e etiológicos envolvidos na gênese dessas síndromes. São discutidos a seguir, particularmente, os resultados obtidos com o tratamento cirúrgico de 11 pacientes com hematoma intracerebral espontâneo. Apesar da divergência de opiniões a este propósito, a melhora acentuada que observamos em 54,6% de nossos doentes, motiva-nos a considerar o tratamento cirúrgico indicado na maioria dos casos de hemorragia cerebral primária.

After brief comments about the angiographic findings on 298 consecutive cases of isquemic or hemorrhagic cerebral vascular strokes, cerebral angiography is emphasized as the main diagnostic method, owing to the variety of physiopathogenic and ethiologic factors involved in the genesis of this syndromes. The results of surgical treatment on eleven patients with spontaneous intracerebral hematomata are discussed in detail. Despite the great divergence among the authors about the management of massive intracerebral hemorrhage, the rapid improvement in 54,6% of the patients in this series, in our opinion justifies surgery in the majority of the cases.

Tratamento cirurgico da hemorragia cerebral: considerações a propósito de 11 casos

Surgical treatment of spontaneous intracerebral hemorrhage: results obtained on eleven cases

Walter C. Pereira^I; Roberto Godoy^II; Celso Ferreira^III

^IChefe do Serviço de Neurocirurgia. Hospital São Joaquim da Real e Benemérita Sociedade Portuguesa de Beneficência de São Paulo

^IINeurocirurgiâo Assistente. Hospital São Joaquim da Real e Benemérita Sociedade Portuguesa de Beneficência de São Paulo

^IIIMédico residente. Hospital São Joaquim da Real e Benemérita Sociedade Portuguesa de Beneficência de São Paulo

RESUMO

Após breves comentários sobre os achados angiográficos em 298 doentes com acidente vascular cerebral isquêmico ou hemorrágico, é realçada a importância da angiografia cerebral como o método ideal de diagnóstico, tendo em vista a variedade de fatores fisiopatogênicos e etiológicos envolvidos na gênese dessas síndromes. São discutidos a seguir, particularmente, os resultados obtidos com o tratamento cirúrgico de 11 pacientes com hematoma intracerebral espontâneo. Apesar da divergência de opiniões a este propósito, a melhora acentuada que observamos em 54,6% de nossos doentes, motiva-nos a considerar o tratamento cirúrgico indicado na maioria dos casos de hemorragia cerebral primária.

SUMMARY

After brief comments about the angiographic findings on 298 consecutive cases of isquemic or hemorrhagic cerebral vascular strokes, cerebral angiography is emphasized as the main diagnostic method, owing to the variety of physiopathogenic and ethiologic factors involved in the genesis of this syndromes. The results of surgical treatment on eleven patients with spontaneous intracerebral hematomata are discussed in detail. Despite the great divergence among the authors about the management of massive intracerebral hemorrhage, the rapid improvement in 54,6% of the patients in this series, in our opinion justifies surgery in the majority of the cases.

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Trabalho realizado no Hospital São Joaquim da Real e Benemérita Sociedade Portuguesa de Beneficência de São Paulo

Serviço de Neurocirurgia - Hospital da Beneficêticia Portuguesa de São Paulo Rua Maestro Car dim 769, sala 275 - 01329 São Paulo SP - Brasil.

1. AKERMAN, A. & NIEMEYER, P. - Hematoma cerebral espontâneo. Med. Cirurg. Farm. 202-203 : 53-71, 1953.
2. ALMEIDA, G. M.; TENUTO, R. A. & VELLUTINI, D. F. - Hematomas intrace-rebrats espontâneos: considerações sobre quatro casos operados. Rev. Hosp. Clin. Fac. Med. S. Paulo 19: 117-124, 1964.
3. ARRIAGADA, C. & VALLADARES, H. - Hemorragia cerebral: revision critica de uma série de 21 casos tratados quirurgicamente. Neurocirurgia 19: 109-120, 1961.
4. ASK-TJPMARK, E. & INGVAR, D. A follow-up examination of 138 cases of subarachnoid hemorrhage. Acta med. scan d. 138: 15-31, 1950.
5. COOK, A. W.; PLAUT, M. & BROWDER, J. - Spontaneous intracerebral hemorrhage: factors related to surgical results. Arch. Neurol. 13 : 25-29, 1965.
6. CRAIG, W. & ADSON, A. W. - Spontaneous intracerebral hemorrhage: etiology and surgical treatment with report of nine cases. Arch. Neurol. Psychiat. (Chicago) 35 : 701-716, 1936.
7. FALCONER, M. A. - Surgical treatment of spontaneous intracerebral hemorrhage. Brit. Med. J. 1: 790-792, 1958.
8. FASANO, V. A. & BROGGI, G. - Aspect clinique et chirurgical de l'hemorragie cérébrale. Neuro-Chirurgie 2 : 357-387, 1956.
9. GUY, G.; SIMON, J.; JAVALET, A.; FAIVRE, J. & PECKER, J. - Aspects artériographiques des hématomes intra-cérébraux spontanés: a propôs d'une série de 305 cas. Neuro-Chirurgie 15: 461-469, 3969.
10. HELPERN, M. & RABSON, S. M. - Sudden and unexpected natural death: spontaneous subarachnoid hemorrhage. Amer. J. med. Sc. 220 : 262-271, 1950.
11. LAZORTHES, G. - L'hemorragie Cérébrale Vue par le Neurochirurgien. Masson, Paris, 1956.
12. LAZORTHES, G. - Surgery of cerebral hemorrhage: report on the results of 52 surgically treated cases. J. Neurosurg. 16 : 355-364, 1959.
13. LEVY, L. F. - Subarachnoid haemorrhage without arteriographic abnormality. J. Neurosurg. 17 : 252-258, 1960.
14. MARGOLIS, G.; ODOM, G. L.; WOODHALL, B. & BLOOR, B. M. - The role of small angiomatous malformations in the production of intracerebral hematomas. J. Neurosurg. 8 : 564-575, 1951.
15. MARKS, Y. S. - Apoplectic death due to intracerebral hemorrhage: an anatomic study. Neurology 10 : 278-280, I960.
16. MARSHALL, J. - Diagnostico y Tratamento de las Afecciones Cerebrovasculares. Elicien, Barcelona, 1970.
17. Mc CORMICK, W. F. & ROSENFIELD, D. B. - Massive brain hemorrhage: a review of 144 cases and an examination of their causes. Stroke 4: 946-954, 1973.
18. McKISSOCK, W.; RICHARDSON, A. & WALSH, L. - Primary intracerebral hemorrhage: results of surgical treatment in 244 consecutive cases. Lancet 2: 683-686, 1959.
19. McKISSOCK, W.; RICHARDSON, A. & TAYLOR, J. - Primary intracerebral hemorrhage: a controlled trial of surgical and conservative treatment in 180 unselected cases. Lancet 2: 221-226, 1961.
20. MILLER, F. C. - The pathologic and clinical aspects of thalamic haemorrhage. Trans, amer. neurol. Ass. 84: 56-59, 1959.
21. MAYRAC, L. & DELANTSHEER, D.--Quelques remarques étiologiques à propôs d'une série de vingt hématomes spontanés du cerveau et du cervelet. Rev. neurol. 89: 591-599, 1954 .
22. PAILLAS, J. E. & ALLIEZ, B. - Surgical treatment of spontaneous intracerebral hemorrhage: immediate and long-term results in 250 cases. J. Neurosurg. 39: 145-151, 1973.
23. PARKINSON, D. - The problem of spontaneous subarachnoid hemorrhage with proven aneurysm. J. Neurosurg. 12: 565-569, 1955.
24. PECKER, J. - L'hematome intra-cérébrale spontané. Presse méd. 68: 367-395, 1960.
25. PEREIRA, W. C. - Hemorragias subaracnóideas: estudo angiográfico de 223 casos. Rev. Paul. Med. 67: 211-217, 1965.
26. PERRIA, L.; TARTARINI, E. & CRUDELLI, R. - Ematomi intracerebral! spontanea Sist. nerv. 8: 271-282, 1956.
27. POUYANNE, H.; BILLET, R.; RASCOL, A. & SALAMON, G. - L'hemorragie cérébrale de G hypertension artérielle (mesa redonda). Neuro-Chirurgie 20: 284-332, 1974.
28. RANSOHOFF, J.; DERBY, B. & KRICHEFF, I. - Spontaneous intracerebral hemorrhage. Clin. Neurosurg. 18: 247-266, 1970.
29. RIISHEDE, J. - Les hématomes intra-cérébraux spontanés: a propôs de 4 observations. Rev. neurol. 83: 342-350, 1950.
30. SAHS, A. L.; PERRET, G.; LOCKSLEY, H. & NISHIOKA, H. - Intracranial Aneurysms and Subarachnoid Hemorrhage: A Cooperative Study. Lippincott, Philadelphia, 1969.
31. SALAMON, G.; BOUDOURESQUES, J.; COMBALBERT, A.; KHALIL, R; FAU-RE, J. & GIUD1CELLI, G. - Les arères lenticulo-striées, étude artériographique: leur intérêt dans le diagnostic des hématomes intracérébraux. Rev. neurol. 144: 361-373, 1966.
32. SCOTT, M. - Neurosurgical treatment of spontaneous intracranial hemorrhage: importance of differential diagnosis in cerebral apoplexy and evaluation of long-term postoperative results. J. Amer. med. Ass. 172: 889-895, 1960.
33. TAVERNIER, J. B.; WOLINETZ, E. & MINUIT, P_; - A propos d'une série de 65 cas d'hématomes intracérébraux spontanés. Neuro-Chirurgie 2: 413-415, 1956.
34. WERNER, A. - A study of eight surgically treated cases of spontaneous sub-cortical haematoma. J. Neurosurg. Psychiat. 17: 57-69, 1954.

Datas de Publicação

Publicação nesta coleção
29 Ago 2012
Data do Fascículo
Mar 1977

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. AKERMAN, A. & NIEMEYER, P. - Hematoma cerebral espontâneo. Med. Cirurg. Farm. 202-203 : 53-71, 1953.

[2] 2. ALMEIDA, G. M.; TENUTO, R. A. & VELLUTINI, D. F. - Hematomas intrace-rebrats espontâneos: considerações sobre quatro casos operados. Rev. Hosp. Clin. Fac. Med. S. Paulo 19: 117-124, 1964.

[3] 3. ARRIAGADA, C. & VALLADARES, H. - Hemorragia cerebral: revision critica de uma série de 21 casos tratados quirurgicamente. Neurocirurgia 19: 109-120, 1961.

[4] 4. ASK-TJPMARK, E. & INGVAR, D. A follow-up examination of 138 cases of subarachnoid hemorrhage. Acta med. scan d. 138: 15-31, 1950.

[5] 5. COOK, A. W.; PLAUT, M. & BROWDER, J. - Spontaneous intracerebral hemorrhage: factors related to surgical results. Arch. Neurol. 13 : 25-29, 1965.

[6] 6. CRAIG, W. & ADSON, A. W. - Spontaneous intracerebral hemorrhage: etiology and surgical treatment with report of nine cases. Arch. Neurol. Psychiat. (Chicago) 35 : 701-716, 1936.

[7] 7. FALCONER, M. A. - Surgical treatment of spontaneous intracerebral hemorrhage. Brit. Med. J. 1: 790-792, 1958.

[8] 8. FASANO, V. A. & BROGGI, G. - Aspect clinique et chirurgical de l'hemorragie cérébrale. Neuro-Chirurgie 2 : 357-387, 1956.

[9] 9. GUY, G.; SIMON, J.; JAVALET, A.; FAIVRE, J. & PECKER, J. - Aspects artériographiques des hématomes intra-cérébraux spontanés: a propôs d'une série de 305 cas. Neuro-Chirurgie 15: 461-469, 3969.

[10] 10. HELPERN, M. & RABSON, S. M. - Sudden and unexpected natural death: spontaneous subarachnoid hemorrhage. Amer. J. med. Sc. 220 : 262-271, 1950.

[11] 11. LAZORTHES, G. - L'hemorragie Cérébrale Vue par le Neurochirurgien. Masson, Paris, 1956.

[12] 12. LAZORTHES, G. - Surgery of cerebral hemorrhage: report on the results of 52 surgically treated cases. J. Neurosurg. 16 : 355-364, 1959.

[13] 13. LEVY, L. F. - Subarachnoid haemorrhage without arteriographic abnormality. J. Neurosurg. 17 : 252-258, 1960.

[14] 14. MARGOLIS, G.; ODOM, G. L.; WOODHALL, B. & BLOOR, B. M. - The role of small angiomatous malformations in the production of intracerebral hematomas. J. Neurosurg. 8 : 564-575, 1951.

[15] 15. MARKS, Y. S. - Apoplectic death due to intracerebral hemorrhage: an anatomic study. Neurology 10 : 278-280, I960.

[16] 16. MARSHALL, J. - Diagnostico y Tratamento de las Afecciones Cerebrovasculares. Elicien, Barcelona, 1970.

[17] 17. Mc CORMICK, W. F. & ROSENFIELD, D. B. - Massive brain hemorrhage: a review of 144 cases and an examination of their causes. Stroke 4: 946-954, 1973.

[18] 18. McKISSOCK, W.; RICHARDSON, A. & WALSH, L. - Primary intracerebral hemorrhage: results of surgical treatment in 244 consecutive cases. Lancet 2: 683-686, 1959.

[19] 19. McKISSOCK, W.; RICHARDSON, A. & TAYLOR, J. - Primary intracerebral hemorrhage: a controlled trial of surgical and conservative treatment in 180 unselected cases. Lancet 2: 221-226, 1961.

[20] 20. MILLER, F. C. - The pathologic and clinical aspects of thalamic haemorrhage. Trans, amer. neurol. Ass. 84: 56-59, 1959.

[21] 21. MAYRAC, L. & DELANTSHEER, D.--Quelques remarques étiologiques à propôs d'une série de vingt hématomes spontanés du cerveau et du cervelet. Rev. neurol. 89: 591-599, 1954 .

[22] 22. PAILLAS, J. E. & ALLIEZ, B. - Surgical treatment of spontaneous intracerebral hemorrhage: immediate and long-term results in 250 cases. J. Neurosurg. 39: 145-151, 1973.

[23] 23. PARKINSON, D. - The problem of spontaneous subarachnoid hemorrhage with proven aneurysm. J. Neurosurg. 12: 565-569, 1955.

[24] 24. PECKER, J. - L'hematome intra-cérébrale spontané. Presse méd. 68: 367-395, 1960.

[25] 25. PEREIRA, W. C. - Hemorragias subaracnóideas: estudo angiográfico de 223 casos. Rev. Paul. Med. 67: 211-217, 1965.

[26] 26. PERRIA, L.; TARTARINI, E. & CRUDELLI, R. - Ematomi intracerebral! spontanea Sist. nerv. 8: 271-282, 1956.

[27] 27. POUYANNE, H.; BILLET, R.; RASCOL, A. & SALAMON, G. - L'hemorragie cérébrale de G hypertension artérielle (mesa redonda). Neuro-Chirurgie 20: 284-332, 1974.

[28] 28. RANSOHOFF, J.; DERBY, B. & KRICHEFF, I. - Spontaneous intracerebral hemorrhage. Clin. Neurosurg. 18: 247-266, 1970.

[29] 29. RIISHEDE, J. - Les hématomes intra-cérébraux spontanés: a propôs de 4 observations. Rev. neurol. 83: 342-350, 1950.

[30] 30. SAHS, A. L.; PERRET, G.; LOCKSLEY, H. & NISHIOKA, H. - Intracranial Aneurysms and Subarachnoid Hemorrhage: A Cooperative Study. Lippincott, Philadelphia, 1969.

[31] 31. SALAMON, G.; BOUDOURESQUES, J.; COMBALBERT, A.; KHALIL, R; FAU-RE, J. & GIUD1CELLI, G. - Les arères lenticulo-striées, étude artériographique: leur intérêt dans le diagnostic des hématomes intracérébraux. Rev. neurol. 144: 361-373, 1966.

[32] 32. SCOTT, M. - Neurosurgical treatment of spontaneous intracranial hemorrhage: importance of differential diagnosis in cerebral apoplexy and evaluation of long-term postoperative results. J. Amer. med. Ass. 172: 889-895, 1960.

[33] 33. TAVERNIER, J. B.; WOLINETZ, E. & MINUIT, P_; - A propos d'une série de 65 cas d'hématomes intracérébraux spontanés. Neuro-Chirurgie 2: 413-415, 1956.

[34] 34. WERNER, A. - A study of eight surgically treated cases of spontaneous sub-cortical haematoma. J. Neurosurg. Psychiat. 17: 57-69, 1954.