This surgical decision must be made individually

Cerebral hemorrhagesA cerebral hemorrhage is a bruise in brain tie caused by the rupture or bursting of a blood vessel in the brain. Due to the lack of blood supply to the brain regions dependent on the damaged vessel as well as the space-occupying effect of the accumulation of blood. The associated increase in intracranial prere results in functional disorders in the affected area. In some cases it leads to the death of brain cells. The occurrence of a cerebral hemorrhage should always be classified as a severe clinical emergency. In certain cases, a brain hemorrhage is relieved by surgery. Depending on the location of the hemorrhage, a distinction is made between epidural, subdural, subarachnoid or intracerebral hemorrhages. Causes can be craniocerebral trauma (injuries), vascular malformations or other underlying diseases (arterial hypertension, amyloid angiopathy (deposits of protein components in the blood vessels)).

Subarachnoid hemorrhages

This op decision must be made individually

These are hemorrhages between the brain surface and soft meninges (so-called. Pia mater). Often it also bleeds into the brain chambers (ventricles). These hemorrhages can occur in the context of a craniocerebral trauma, but can also occur spontaneously. As a rule, the rupture of a cerebral artery aneurysm is then present. In approx. 10 – 20 % of the cases no trigger can be found. The clinical picture ranges from mild headaches to life-threatening conditions with severe neurological deficits, depending on blood volume and blood distribution. After the onset of such a hemorrhage, further complications can arise in the course of the disease. Reactive constriction of cerebral vessels can lead to circulatory disorders of the brain. Blood clots can cause disturbances in cerebrospinal fluid circulation. In this case, hydrocephalus (= hydrocephalus) would be the consequence. Ultimately, it is always a severe clinical picture that always requires clarification and always requires inpatient, usually even intensive medical monitoring.

Evidence of extensive subarachnoid blood collections (outlined in red)

Intracerebral hemorrhages

This surgical decision must be made individually

This is bleeding directly into the brain tie. Apart from hemorrhages from cerebral vascular malformations, these are most frequently hemorrhages caused by arterial hypertension ("high blood prere"). Also skull – brain trauma and other vessel wall changes can be causative. The symptoms depend on the size. Localization of the hemorrhage. Whether and when an operation is performed ultimately depends on the symptoms, the localization and the concomitant diseases. This surgical decision must be made individually.

Computed tomography (CT) shows a hemorrhage (x) in the right hemisphere of the brain with invasion of the right cerebral ventricles (arrows)

Epidural hematoma

This surgical decision must be made on an individual basis

An epidural hematoma is a hemorrhage between the bone and the hard meninges, which is usually traumatic, i.e., it can be treated immediately. h. Occurs in the course of an accident. In this case there is a rupture of an arterial blood vessel with correspondingly rapid formation of a hemorrhage in the brain. g. Area. Due to the increase in size of the hemorrhage, there is increasing prere on the surrounding brain with corresponding symptoms. Patients often present with the following complex of symptoms: After a short period of unconsciousness in the context of the head trauma, the patients regain consciousness. As the size of the hemorrhage increases, the prere on the brain increases. Patients get progressively worse. The consciousness increasingly deteriorates to coma, hemiplegia may occur and without treatment the hemorrhage will lead to death. For this reason, an epidural hemorrhage (depending on its extent) often requires immediate neurosurgical intervention. The skull bone must be opened. The hematoma must be surgically removed. At the same time, the bleeding vessel is occluded here. The prognosis of an epidural hematoma, which is treated in a timely manner, is very good, since there are often no concomitant brain injuries.

Subdural hematoma (subdural hemorrhage)

This surgical decision must be made individually

A subdural hematoma is a hemorrhage between the hard meninges and the brain. The source of bleeding is often veins that run through the subdural space. The subdural hematoma also usually develops in the context of an accident, but spontaneous hemorrhages are also possible. Depending on the temporal course, a distinction is made between acute, subacute and chronic subdural hematomas. In acute subdural hematoma, hemorrhage into the subdural space occurs within a few hours with increasing prere on the surrounding brain and corresponding symptoms. Since brain injuries are often present at the same time, the prognosis for acute subdural hematoma is much worse; the lethality of acute subdural hematoma is 30 to 80 % depending on the extent and size of the hematoma.

The only therapeutic option is immediate surgery with evacuation of the hematoma. Chronic subdural hematomas usually occur after minor trauma, with a small hemorrhage into the subdural space, which chronically enlarges over the course of the next few weeks. Accordingly, the clinical symptoms were also rather mild at first, with headaches frequently present. Sometimes a change in nature occurs and, depending on the course, focal signs such as paralysis, loss of sensation or, often, epileptic seizures may then occur. Here, too, the therapy is usually surgical.

Vascular Neurosurgery

This branch of neurosurgery deals with congenital or acquired vascular malformations in or on the brain.

The most important are the so-called cerebral artery aneurysms, arteriovenous hemangiomas, cavernomas and, more rarely, dural arteriovenous fistulas. What all these diseases have in common is that they cause a "brain hemorrhage" can be triggered. These are either subarachnoid hemorrhages, intracerebral hemorrhages, and in some cases sometimes subdural or epidural hemorrhages. All of these bleeds can be of varying degrees. In the worst case, fatal consequences. The risk of bleeding alone indicates the need for sufficient treatment.

cerebral artery aneurysms (aneurysm)

Aneurysms are bulges in the wall of cerebral blood vessels, i.e. a widening of the vessels in the brain. As a rule, a vessel wall weakness is congenital and in the course of life, due to the pulsations of the blood flow, just such expansions form, which then continue to increase in size. The most common initial symptom is subarachnoid hemorrhage, which occurs when an aneurysm suddenly bursts (ruptures). This is an acute, very severe and always life-threatening condition. Some aneurysms become symptomatic due to their increasing size, with the aneurysm sac compressing surrounding brain tie or nerves, causing neurological deficits. Treatment depends on the location of the aneurysm, its configuration and the clinical condition of the patient. In principle, the following are available. Neuroradiologic – interventional procedures available.

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