小骨窗经侧裂入路显微手术治疗高血压基底节脑出血患者回顾性分析

Microsurgical treatment of hypertensive basal ganglia hemorrhage through transsylvian approach via small bone window: a retrospective analysis

摘要:

目的 回顾性分析小骨窗经侧裂入路显微手术结合医用胶整复颅骨治疗高血压基底节脑出血的手术要点及疗效。方法 选择2010年6月至2014年5月收治的31例高血压基底节脑出血(Hypertensive basal ganglia hemorrhage, HBGH)患者,采用小骨窗经侧裂入路显微手术清除血肿,术毕使用医用胶将颅骨碎片和骨屑黏合复位。结果 患者全部存活,血肿清除率达90%以上者26例,70%~90% 5例;术后1个月、6个月头颅CT检查显示颅骨外形良好,未见头骨膨出、内陷和脑受压,无皮下积液。术后6个月ADL评分结果为:Ⅰ级11例,Ⅱ级15例,Ⅲ级4例,Ⅳ级1例。结论 采用小骨窗经侧裂入路显微手术结合医用胶整复来治疗高血压基底节脑出血,血肿清除率高,患者术后康复较好,并发症少,颅骨外形良好,而且成本低,方法简便,适于在硬件设备相对落后的基层医院使用。

Abstract:

Objective To retrospectively analyze the operating points and effect of microsurgery through the transsylvian approach via a small bone window combined with medical adhesive for repairing skull in the treatment of hypertensive basal ganglia hemorrhage (HBGH).Methods A retrospective analysis was performed on 31 patients with HBGH admitted from June 2010 to May 2014. These patients underwent microsurgery through the transsylvian approach via a small bone window to remove hematoma. The skull fragments and bone chips were remodeled according to the original shape with medical adhesive after operation.Results All patients survived. The hematoma clearance rate was over 90% in 26 patients and 70%-90% in 5 patients. The brain CT re-examinations at 1 and 6 months after operation showed that the skull was in good shape, skull bulging and depression and compression of the brain were not observed, and scalp hydrops was not found. As for the Activities of Daily Living scores, there were 11 grade I cases, 15 grade II cases, 4 grade III cases, and 1 grade IV case at 6 months after operation.Conclusions Treated with microsurgery through the transsylvian approach via a small bone window combined with medical adhesive, HBGH patients have high hematoma clearance rate, good postoperative rehabilitation, few postoperative complications, and good skull shape. This surgical procedure has low cost and easy operation, and is suitable for use in primary hospitals with less advanced equipment.