目的 探讨基底节区高血压脑出血手术治疗的时机、方式及疗效。 方法 回顾性分析2006年1月－2011年1月行开颅手术治疗的基底节区高血压脑出血168例患者临床资料。其中男98例，女70例；年龄35～84岁，平均65.2岁。患者发病至入院时间30 min～48 h，平均7.1 h。入院时患者意识状态分级：Ⅰ级32例，Ⅱ级46例，Ⅲ级41例，Ⅳ级28例，Ⅴ级21例。入院头部CT检查示外侧型51例，内侧型71例，混合型46例。血肿量25～50 mL 76例，50～80 mL 53例，＞80 mL 39例。采用小骨窗开颅血肿清除术127例，行骨瓣开颅血肿清除术41例。 结果 168例患者中，死亡16例（9.52%）。术后4～28 h再出血8例，立即再次手术清除血肿6例，非手术治疗2例，致死亡4例；死于血肿量过大或脑疝6例，肺部、尿路感染3例，多器官功能衰竭3例。出院时按格拉斯哥预后量表评分，恢复良好82例，中残46例，重残16例，植物生存8例，死亡16例。术后随访3～6个月，按日常工作能力分级，Ⅰ级33例，Ⅱ级49例，Ⅲ级54例，Ⅳ级8例，Ⅴ级8例。 结论 超早期或早期在直视下手术，彻底清除血肿，术中对出血的责任血管可靠电凝止血，术后再出血发生率低，术后恢复快，疗效满意。
ObjectiveTo explore the advantages and operation skills of ultra-early small bone window craniotomy surgery on cerebral hemorrhage in basal ganglia regions. MethodsWe retrospectively analyzed the clinical data of 58 patients with cerebral hemorrhage in basal ganglia regions who underwent ultra-early small bone window craniotomy between January 2009 and December 2012. ResultsPatients within 24 hours after surgery were re-checked by CT scan, which showed that hematoma was cleared in 53 cases, most removed in 2 cases, re-hemorrhage occurred in 2 patients whose hematoma was immediately removed by the original incision, 1 patient had large area infarction and underwent bone flap decompression. According to Glasgow outcome scale score at discharge, the outcome was good in 23, moderate disability in 18, severe disability in 12, persistent vegetative state in 2 and 3 were dead. ConclusionUltra-early skull-window craniotomy can timely and completely remove the hematoma, provide reliable coagulation, protect important arteries with less re-hemorrhage and excellent outcome, which is one of the most effective methods for treating cerebral hemorrhage in basal ganglia regions.
ObjectiveTo explore and compare the therapeutic effects of neuro-endoscopic and craniotomic hematoma evacuation for hypertensive hematomas in the basal ganglia region. MethodsEighty-six patients with hypertensive hematomas in the basal ganglia regions treated between January 2010 and September 2014 were divided into neuro-endoscopy and craniotomy groups randomly with 43 in each. Hematoma was removed directly under neuro-endoscope in the endoscopic group, while it was removed under the operating microscope in the craniotomy group. The average operation bleeding amount, residual hematoma after operation, hematoma evacuation rate, the changes of National Institutes of Health Stroke Scale (NIHSS) and Barthel index (BI) scores before operation, 1 and 3 months after operation were compared between the two groups. All data were analyzed statistically. ResultsThe average amount of operation bleeding was (127±26) mL, postoperative residual hematoma was (6±4) mL, and the hematoma clearance rate was (86±9)% in the neuro-endoscopy group, while those three numbers in the craniotomy group were respectively (184±41) mL, (11±6) mL, and (72±8)%, with all significant differences (P < 0.05). The NIHSS and BI scores were not significantly different between the two groups before surgery (P > 0.05). Seven days, one month and three months after surgery, the NIHSS score was significantly lower, and the BI score was significantly higher in the neuro-endoscopy group than the craniotomy group (P < 0.05). ConclusionNeuro-endoscopic surgery for hypertensive hematomas in basal ganglia region is proved to have such advantages as mini-invasion, direct-vision, complete clearance and good neural function recovery after surgery, which is a new approach in this field.
ObjectiveTo compare the keyhole approach and traditional craniotomy in the treatment of basal ganglia region hypertension cerebral hemorrhage postoperative epileptic curative effect comparison keyhole approach and traditional craniotomy in the treatment of basal ganglia region the curative effect of hypertensive cerebral hemorrhage postoperative epilepsy. MethodsCollected cases of basal ganglia region admitted in department of neurosurgery our hospital from September 2006 to March 2015, 108 cases of hypertensive cerebral hemorrhage patients, randomly divided into two groups:keyhole approach group (58 cases) and conventional surgery group (50 cases).Two groups of patients with perioperative all use the same management scheme, using statistical methods to analyze clinical data of two groups of patients, such as age, sex, blood loss, postoperative epilepsy, drug efficacy and the incidence of adverse drug reactions, etc. ResultsPostoperative follow-up of 2 years, keyhole approach group 12 cases sufferred postoperative seizure, 1 case of patients with status epilepticus, no death occurred; a total of 10 cases of mono-antiepileptic drug(AEDs) therapy effectively, and 7 cases present adverse drug reactions; Traditional surgical postoperative seizures 22 cases, 9 cases occurred status epilepticus, and five died as a result, only five were effective for single therapy, and 15 cases with adverse drug reactions.Statistical results suggest the incidence of postoperative epilepsy, the incidence of severe epilepsy, prognosis, single drug control and adverse drug reactions between the tuo groups have significant difference (P < 0.05). ConclusionCompared with traditional craniotomy for removal of hematoma, keyhole approach greatly reduce the incidnce of basal ganglia region hypertension cerebral hemorrhage postoperative complications, severe epilepsy and adverse reaction of AEDs.Therefore, keyhole approach in the treatment of basal ganglia region hypertension cerebral hemorrhage is an admirable way of treatment.