[Classifications and therapeutic indications in spontaneous intracerebral hematomas in the absence of any vascular malformation. Preliminary study apropos of 65 cases].

CT Scan and I.C.P. monitoring help us in management of spontaneous intracerebral haemorrhage to decide if surgical evacuation is necessary or not. The various opinions expressed in literature seem to depend on the lack of correlations between clinical state, CT Scan and I.C.P. monitoring. Three groups of patients were studied: Group I: patients with ingravescent coma during the first three days. Their natural history is death. Group 2: patients with disturbances of consciousness which appear, persist or increase during the first week. Group 3: awake patients with spontaneous improvement. In group I: Patients in cortico-subcortical or diencephalic stage (according to Plum and Posner) or with clinical signs of uncus hernia have been operated on: three deaths out of eleven cases. But patients in mesodiencephalic stage or worse all died (14 cases). In group 2: Three reasons indicated surgery: first, patients with clinical deterioration; second, patients with increasing of the Shift of Septum Lucidum on CT Scan; third, patients with I.C.P. increasing. In group 3: No operation was necessary. CT Scan allowed to separate three sites of the hematoma: Deep or in basal ganglia, superficial or lobar, and a middle class of hematoma who can also be called a middle hemispheric hematoma. It allowed to separate its size, big: more than 3 cm of biggest diameter, and little. In case of middle or labor hematomas, surgical management is very simple. We performed a little craniotomy (3 X 4 cm) with holl drill, short cortical incision, and clots were sucked carefully without damaging the walls of the cavity.(ABSTRACT TRUNCATED AT 250 WORDS)