Spontaneous Intracerebral Hematoma

W HEN Macewen 8 performed the first successful operation for intracerebral hematoma in 1883, it was also among the earliest neurosurgical procedures undertaken. The patient, who had had a brachial monoplegia, made a rapid and complete recovery. Although Cushing described two cases of traumatic intracerebral hematoma in 1903, 4 it was not until 1932 that the subject was more clearly elucidated by Bagley, 1 who identified the type of patient that would tend to benefit by surgical treatment. In recent years 3,5,9,n much has been written on the role of small vascular malformations in the etiology of this lesion. This paper will be confined to the report and discussion of so-called spontaneous intracerebral hematomas; hematomas from aneurysms, large arterial venous malformations as well as hypertensive and traumatic hemorrhages, have been excluded from this series. The postoperative improvement in these patients has suggested to us that the pathological process in spontaneous intraeerebral hematoma involves not only local necrosis but a separation of fiber fascicles with a resultant physiological block, which can be reversed by evacuation of the hematoma.