Factors Affecting Treatment Outcome in Traumatic Intracerebral Hematomas

Current indications for surgical treatment of patients with traumatic intracerebral hematomas (TICH), generally observed after severe head traumas are unclear. Therefore, mortality and morbidity rates are higher in such cases. In the present study, the aim was to evaluate patients diagnosed with TISH in line with the literature. The archived medical records of patients (n=56) diagnosed with TICH between January 1991- January 1997 in the neurosurgery clinic were scanned. The alpha significance value was accepted as < 0.05 during the evaluation of the obtained data. After initial neurological examinations of patients, 21 patients were diagnosed with mild head trauma (GCS: 13-15), 20 patients were diagnosed with moderate head trauma (GCS: 9-12), and 15 patients were diagnosed with severe head trauma (GCS: 3-8). 71.4% (n = 40) of these patients with TICH had concomitant multiple intracranial pathologies. CT scans revealed that 36 patients had cisternal compression and that 20 patients had not any cisternal compression. As a treatment modality, 53.6% (n = 30) of the patients were treated with conservative treatment, while the remaining patients (n = 26) underwent surgical treatment. Surgical intervention may be required in patients with midline shift greater than 5 mm at the level of the ventricle, and it should be kept in mind that if the volume of hematoma constitutes 4-8% of the total volume of the brain, this may pose a serious life-threat to the life of patients. An open or closed perimesencephalic cistern may be an important indicator for intracranial pressure. It should also be kept in mind that the localization of cerebral oedema and hematoma is important for surgical treatment.