Oblyvach A. Nontraumatic hemorrhages of posterior cerebral fossa. Clinical presentation diagnostics and treatment In the early period

The thesis is devoted for the problem of optimization of diagnostics and treatment approaches for the nontraumatic hemorrhages of posterior cerebral fossa nervous structures. Material of this thesis is based on the research of the disease's clinical presentation and peculiarities of natural history, analysis of modern instrumental diagnostics' possibilities and the results of treatment of 125 patients with nontraumatic posterior cerebral fossa hemorrhages.There was developed and applied the diagnostic algorithm with straight sequence of clinical estimations and instrumental diagnostic studies for different types of apoplectic lesions in posterior cerebral fossa. There were defined criteria for differential selection of surgical management, and specified features of surgical approach. There was performed an analysis of effectiveness of surgical approach depending on type of clinical course of the disease, hemorrhage site and volume, presence or absence of occlusive hydrocephalus. It was established, that the most active surgical treatment was indicated for patients with cerebellar hemorrhages larger than 20 cc, that were confused or soporose at admission (GCS score 10 - 14). Surgical treatment in this group of patients was the most effective. Mortality rate was 28.5%. Emergency surgery in case of brain stem hemorrhages was reduced to the ventricular draining in case of occlusive hydrocephalus development.