The need for surgery for intracranial hematoma
Intracranial hematoma is accumulation of blood inside the skull, which puts pressure on the brain interferes with the normal circulation and blocks the access of oxygen to the brain. Among the consequences of this is amnesia, intellectual impairment, anxiety, impaired attention, post-traumatic seizures. If you do not start in a timely manner to treat this disease, there is a risk of development of brain edema with lesions of the brain tissue and its subsequent destruction. The symptoms of intracranial accumulations of blood often appear immediately, but after some time after the formation of the pathological state.
And this is complicated by the possibility of timely detection of disease that sometimes leads to the emergence of irreversible processes in the brain. Depending on the time of the manifestation of clinical symptoms are distinguished:
- Acute, manifesting itself within 3 days from the moment of formation.
- Subacute, manifested for 3 weeks.
- Chronic, manifested in 3 weeks or more since the occurrence.
Intracranial collections of blood in the average size have a volume of 50-100 ml, and of course their size may be smaller or larger. Small collections of blood can sometimes go away on its own; the size of the hematoma of more than 150 ml is fatal.
Classification of hematomas and clinical manifestations
The symptoms depend on the localization of hematoma, its size, age of the patient. Klassificeret hematoma following way:
- Epidural - located over the hard shell of the brain. Occur when the artery or vessel between the skull and the outer surface of the hard shell of the brain. As in the arteries and blood vessels high blood pressure, when they rupture the blood drains quickly, so this type of hematoma has the acute effects. Possible symptoms usually occurs within a few days, and sometimes hours are: headache, drowsiness, confusion, seizures, paralysis, progressive enlargement of pupil on side of hematoma, progressive paresis, coma. In children this swelling develops very quickly.
- Subdural - located between the hard shell and the brain substance. Formed in the process of breaking vein connecting the sinus Dura and the venous system of the brain. Blood pressure in veins is less than in arteries, so blood flows slowly and a hematoma may not Express itself for 2-3 weeks. Signs of a subdural hematoma vary depending on the age of the person. For example, in young childrencan increase the head; in persons younger than 35 years, the appearance of hematoma is expressed in headaches, nausea and vomiting, epileptic seizures, convulsions, and sometimes widens the pupil from the swelling.
- Intracerebral, intraventricular hematomas are located within the main brain or the ventricles of the brain. Clinical presentation: headache (often on one side), dizziness, loss of consciousness, vomiting. When an injury is bleeding in the brain, affects the white substance, and the neurites or axons - the long processes of nerve cells, which come from the neurons nerve impulses to other cells or organs. This is the reason why such a hematoma can cause paralysis and convulsions.
- Hematomas of the brain stem are fatal.
- Diapedesis may result from hemorrhage of the blood vessels (hemorrhagic infarction) because of their increased permeability. With this defeat the patient experiences severe sharp headache.
The reasons for the formation of intracranial hematomas
Intracranial hematomas occur for the following reasons:
- Traumatic brain injury - the most common cause of hematomas.
- Diseases of the blood, vascular system, oncological diseases, infections, and strokes may contribute to thinning and rupture of blood vessels.
The methods of diagnosis and treatment of intracranial hematomas
To reliably diagnose an intracranial hematoma, you can use:
- CT - computed tomography, a technology that enables to study the layers of the brain. For this use x-rays.
- MRI - magnetic resonance imaging, layer-by-layer study of the brain on the basis of nuclear magnetic resonance.
After the diagnosis is assigned the necessary treatment. Conservative therapy is the appointment of drugs that reduce intracranial pressure and promote resorption of hematomas. Along with the appointment of medicines prescribed bed rest, however, this technique helps only in some cases, often need surgical removal of the hematoma.
The operation and recovery after
The procedure for removal of intracranial hematoma is performed under General anesthesia. There are several methods of operation:
- Bone-plastic trepanation. In the skull produce a small hole. Then the accumulation of blood that will removes with the help of specialvacuum, in the presence of dense blood clots using forceps. The damaged area is washed with sodium chloride solution in this area is placed hemostatic gauze or washcloth to stop bleeding.
- Stereotactic removal. This procedure is carried out at a stroke, as it is more gentle, but that's why and a higher risk of recurrence. In the skull is drilled a small opening through which the cavity of the hematoma, we introduce a special tube (cannula) that manufactures blood collection from the affected areas by the method of aspiration (suction occurring due to low pressure). To monitor the process uses a special navigation system.
- Puncture-aspiration - removal puncturing the hematoma with a needle and the introduction of a special catheter (cannula) through which the blood is extracted in the amount of ½ or 1/3 of the total volume of the hematoma. The tube stays in for a few days is the procedure. Sometimes the cavity bleeding administered drugs designed to dissolve the clot for ease of aspiration.
After the procedure, the patient is prescribed taking anti-seizure medication if the cause of the hematoma was injured.
It is also necessary to control the level of intracranial pressure, enhancing the development of cerebral edema, which may persist for up to 14 days after surgery.
The patient undergoing such a complicated surgery, must be under strict medical supervision and follow all his instructions.
Postoperative recovery period of at least 6 months, but ultimately, it all depends on the individual characteristics of the patient and his age (the younger the person, the faster and easier it is in the recovery).
Complications after surgery to remove a hematoma and contraindications to its conduct
Possible complications after surgery for removal of intracranial hematomas:
- impaired attention;
- swelling of the brain;
- recurrence of bleeding.
Surgical therapy is contraindicated if the patient is in a serious coma, that is, when it is clear that the patient will not survive during surgery.
In addition, the procedure is not performed if the hematoma is not life threatening person and does not cause serious neurological disorders. In such cases, the operation, on the contrary, can worsen the condition because of subsequent complications.