ORIGINAL
Introdução: HICP é o sangramento intracerebral agudo e organizado, decorrente de causas primárias, destacando-se a hipertensão arterial sistêmica. É uma entidade comum de altíssima morbimortalidade. Todavia, suas indicações cirúrgicas são controversas. Objetivo: Analisar parâmetros clínicos e tomográficos para classificação dos pacientes com HICP entre candidatos ao tratamento conservador ou cirúrgico. Métodos: Estudo observacional, prospectivo com 532 pacientes, com HICP e hipertensão, atendidos entre abril de 2002 e 2016. Resultados: Os principais achados clínicos foram déficit motor e obnubilação. A topografia mais prevalente foi lobar e 40% associaram-se com hemoventrículo. Um total de 55% foi operado, sendo craniotomia e derivação ventricular externa as mais realizadas. Os preditores do tratamento cirúrgico foram topografia lobar, presença de hemoventrículo e volume do hematoma entre 31-50 ml. Observou-se letalidade de 49% com tendência a redução entre os operados. Esse benefício foi maior nos HICP lobares entre 31-50 ml e com lesão talâmica ou nuclear associados a hemoventrículo. Conclusão: O estudo identificou os principais parâmetros associados à indicação do tratamento cirúrgico e ao desfecho positivo em pacientes com HICP. Embora sejam necessários estudos complementares, sugere-se considerar cirurgia nos HICP talâmicos ou nucleares com 31-50 ml associados a hidrocefalia por hemoventrículo e HICP lobares com 31-50 ml e Escala de Coma de Glasgow e Pupilas (ECG-P) > 3.
Introduction: PICH is acute and organized intracerebral bleeding, resulting from primary causes, especially systemic arterial hypertension. It is a common entity with high morbidity and mortality. However, its surgical indications are controversial. Objective: to analyze clinical and tomographic parameters to classify patients with PICH as candidates for conservative or surgical treatment. Methods: Observational, and prospective study with 532 patients with HICP and hypertension treated between April 2002 and 2016. Results: The main clinical findings were motor deficit and obtundation. The most prevalent topography was lobar and 40% were associated with hemoventricle. A total of 55% were operated, with craniotomy and external ventricular shunting being the most performed. The predictors of surgical treatment were lobar topography, presence of hemoventricle and volume between 31-50 ml. A lethality rate of 49% was observed, with a tendency to decrease among those undergoing surgery. This benefit was greater in lobar PICH between 31-50 ml and with thalamic or nuclear lesions associated with hemoventricle. Conclusion: The main parameters associated with the indication of surgical treatment and the positive outcome in patients with PICH were identified. Although further studies are needed, it is suggested to consider surgery in thalamic or nuclear PICH with 31-50 ml associated with hemoventricle hydrocephalus and lobar PICH with 31-50 ml and Glasgow Coma Scale and Pupils Score (GCS-P) > 3.
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1MD, Neurosurgeon, Neurosurgery Service, Hospital Municipal Salgado Filho – HMSF/RJ, Rio de Janeiro, RJ, Brazil.
2MD, Doctoral Student in Neuroscience, Institute of Biomedical Sciences – ICB, Universidade Federal do Rio de Janeiro – UFRJ, Rio de Janeiro, RJ, Brazil.
3MD, PhD, Oncologist, Emergency Course Supervision, Hospital Municipal Salgado Filho – HMSF/RJ, Rio de Janeiro, RJ, Brazil.
4MD, PhD, Cardiologist, Emergency Course Coordinator, Hospital Municipal Salgado Filho – HMSF/RJ, Rio de Janeiro, RJ, Brazil.
5MD, Neurosurgeon, Emergency Course Preceptor, Hospital Municipal Salgado Filho – HMSF/RJ, Rio de Janeiro, RJ, Brazil.
6MD, Neurosurgeon-in-Chief, Hospital Municipal Salgado Filho – HMSF/RJ, Rio de Janeiro, RJ, Brazil.
Received Sep 26, 2022
Accepted Oct 18, 2022
