神经内窥镜辅助治疗高血压脑出血的手术体会

目的：探讨神经内窥镜在高血压脑出血手术中的应用。方法：总结ZEPLIN神经内窥镜辅助治疗20例高血压脑出血的临床资料。结果：本组病例术后复查CT示血肿完全清除者12例，清除80％以上者8例。随访6个月，GOS优6例，良11例，中、差、死亡各1例。结论：神经内窥镜辅助治疗高血压脑出血具有定位精确可靠，手术侵袭性小，手术并发症少，术后康复快等优点，为高血压脑出血的外科治疗提供了新的前景。     

神经内窥镜辅助治疗高血压脑出血的手术体会

目的 :探讨神经内窥镜在高血压脑出血手术中的应用。方法 :总结ZEPLIN神经内窥镜辅助治疗 2 0例高血压脑出血的临床资料。结果 :本组病例术后复查CT示血肿完全清除者 12例 ,清除 80 %以上者 8例。随访 6个月 ,GOS优 6例 ,良 11例 ,中、差、死亡各 1例。结论 :神经内窥镜辅助治疗高血压脑出血具有定位精确可靠 ,手术侵袭性小 ,手术并发症少 ,术后康复快等优点 ,为高血压脑出血的外科治疗提供了新的前景。     

立体定向神经内窥镜手术治疗小脑出血体会

目的探讨立体定向神经内窥镜手术治疗小脑出血的临床疗效。方法 2004年3月至2009年12月收治小脑出血患者27例,均采用立体定向神经内窥镜手术治疗。结果术后第2天和第7天复查头颅CT,21例血肿完全清除,6例大部分清除。术后6个月按GOS评定疗效,优良率为88.9%(24/27),死亡率3.7%。结论采用立体定向神经内窥镜手术治疗小脑出血对中度以下昏迷、出血量20ml以下的患者疗效理想。     

神经导航下内镜手术治疗不典型自发性脑出血14例

目的探讨神经导航辅助神经内镜技术治疗不典型自发性脑出血的临床疗效和价值。方法 14例不典型自发性脑出血病人采用神经导航辅助神经内镜技术探查血肿,术中取病变组织进行病理学检查。结果 14例患者手术均获成功,血肿清除满意,根据术中探查及术后病理结果进行下一步治疗。结论应用导航辅助神经内镜技术不但可以清除颅内血肿,而且可以进行病因检查,可以作为不典型自发性脑出血手术治疗的手段之一。     

体表投影导向神经内窥镜治疗基底节区脑出血

目的探索体表投影法定位神经内窥镜治疗脑出血的可行性。方法对19例自发性脑出血患者,采取3D-SLICER软件,血肿体表投影导向的方法,利用神经内窥镜清除脑内血肿。以术中一次性见到血肿为定位准确;对比术前术后CT计算血肿清除率及GCS评分。结果 19例均在血肿体表投影的引导下准确到达到血肿,血肿清除率平均90.5%,术后一周GCS评分平均提高2分。结论利用体表投影确定手术的靶点实方便可行,精确度满足临床需要,采取内窥镜手术血肿清除率高。     

自发性小脑出血的诊断及外科治疗

目的探讨自发性小脑出血的临床特征、诊断与手术治疗。方法回顾性分析21例自发性小脑出血患者的临床资料，其中14例行枕骨开窗血肿清除术，7例行脑室外引流＋环枕减压＋血肿清除术。结果6个月后按GOS标准评估预后，死亡4例，重残3例，恢复良好14例。结论早期动态CT扫描和积极的手术干预是降低自发性小脑出血病死率和改善患者预后的关键。     

内窥镜手术治疗高血压脑出血(附15例报告)

目的探索内窥镜术治疗高血压脑出血。方法采用自行研制的脑内窥镜治疗１５例高血压脑出血。结果血肿完全清除者７例,近全清除或大部清除（血肿清除量大于８０％）８例。随访６～２４个月,ＧＯＳ优４例,良８例,中、差、死亡各１例。恢复优良比例达１２／１５。结论内窥镜手术清除脑内血肿具有直视、能止血等优点,是高血压脑出血外科治疗的一种微侵袭性新方法。     

自发性小脑出血的外科治疗

目的探讨经外科治疗自发性小脑出血的疗效及方案。方法自发性小脑出血患者37例,手术治疗31例,依据血肿部位可分别采用CPA"S形"入路、旁正中入路、后正中入路。显露枕大孔后缘甚至寰椎后弓,骨窗开颅,显微镜下清除血肿。结果血肿残余量在20%28例,残余量20%3例,术后死亡2例。随访病例中,小脑齿状核出血者多为眩晕及肢体共济失调为主症,蚓部出血者以躯体平衡障碍为主症,吞咽功能障碍多在咽期困难。结论手术治疗自发性小脑出血,显微镜下清除血肿,加强术后管理,疗效良好。     

神经内窥镜临床应用的初步经验

本报告20例接受神经内窥镜手术治疗的病例，病种包括自发性颅内血肿16例，室管膜囊肿2例，蛛网膜囊肿2例，手术处理分别为血肿清除，囊肿-脑室或囊腔-脑池造瘘；并结合献对神经内窥镜的临床技术和应用加以讨论。     

神经导航定向内窥镜下微创治疗高血压脑出血

目的 探讨神经内窥镜及导航系统在高血压脑出血手术中的应用。方法 对25例高血压脑出血患者采取在神经导航引导、内窥镜辅助下行血肿穿刺清除治疗,并予以尿激酶灌注引流残余血肿,随访6个月,对治疗结果以KPS评分进行评价。结果 本组25例患者血肿量20～40ml9例;40～60ml16例。术后即刻复查CT血肿清除率在30%～70%16例;大于70%9例。治疗后6个月KPS评分80～100分14例;60～70分8例;30～50分2例;1例死亡。结论 神经导航引导、内窥镜辅助下行血肿穿刺清除,辅以尿激酶灌注引流治疗高血压脑出血,具有微创性、精确性、直视性、简便性、灵活性等优点,为高血压脑出血的治疗提供了良好的前景。     

Spontaneous intracerebral haemorrhage following evacuation of chronic subdural hematomas.

Spontaneous intracerebral haematoma (ICH) is an extremely unusual complication following the evacuation of a chronic subdural haematoma (CSDH). Good outcome is expected after the drainage of the CSDH and neurological deterioration is a cause for serious concern. Authors report three cases of spontaneous ICH away from the site of surgery following evacuation of a CSDH with a review of literature. Changes in cortical blood flow following decompression of a long standing CSDH may be responsible for the ICH.     

神经内镜在治疗老年人脑室出血中的临床应用

目的比较不同方法治疗老年人脑室出血的临床疗效。方法应用神经内镜治疗老年性脑室出血19例,以单纯侧脑室钻孔引流术治疗同类疾病25例为对照组,并相互比较。结果内镜组脑内或(和)脑室内血肿绝大部分清除者(90%以上)者16例,未发现继发出血,术后无颅内感染,术后6个月对患者进行ADL评分,Ⅰ级8例,Ⅱ级5例,Ⅲ级3例,Ⅳ1例,Ⅴ级1例,死亡1例。侧脑室钻孔组引流组仅有4例脑室内血肿大部分清除(60%以下),1例继发出血,术后颅内感染2例。术后6个月对患者进行ADL(glasgow outcome scale)评分比较,Ⅰ级4例,Ⅱ级7例,Ⅲ级4例,Ⅳ5例,Ⅴ级3例,死亡2例。与内镜组相比术后好转优良率低(P0.05),差异有统计学意义;死亡率差异无统计学意义(P0.05)。结论神经内镜治疗老年性脑室出血具有微创、直视、血肿清除及预后好的优点。     

前循环动脉瘤破裂并脑内血肿的显微手术治疗

目的探讨前循环动脉瘤破裂伴脑内血肿手术方法及疗效。方法前循环动脉瘤破裂并脑内血肿患者29例行显微手术治疗,总结其临床特点:动脉瘤部位、大小、形态、合并脑内血肿大小、形态,术前Hunt-Hess分级、手术方式及三个月随访的格拉斯预后评分。结果 Hunt-Hess分级Ⅲ级10例、Ⅳ级17例、Ⅴ级2例。17例患者术前经常规血管造影,12例行三维CT血管造影(3D-CTA)检查证实。29例术中诊断与术前诊断一致,前交通动脉瘤6例,后交通动脉瘤7例,大脑中动脉瘤16例,29例患者共31枚动脉瘤均成功夹闭,3个月后随访时GOS评分Ⅴ级14例,Ⅳ级7例,Ⅲ级4例,Ⅱ级2例,Ⅰ级2例。结论颅内前循环动脉瘤破裂并脑内血肿患者病情危重,早期夹闭动脉瘤,清除血肿,效果良好。     

Cases of cavernous hemangioma discovered in patients with post traumatic intracerebral hematoma]

Cavernous haemangioma has various forms. The cases with spontaneous intracerebral haemorrhage are most common, but post-traumatic intracerebral haematoma was not reported. The aim of this report is to present cases of cavernous haemangioma with unusual clinical course. In seven patients with post-traumatic intracerebral haematoma, fragments of histologically confirmed cavernous haemangioma tissue situated in the place of haematoma were found. In one case, delayed intracerebral haematoma twenty four hours after trauma and initial CT-scan was observed. On the initial CT-scan in this patient only traumatic changes in the brain without haematoma or tumour were present. In our cases, cavernous haemangioma was situated most frequently in frontal and temporal region, shown as haematoma usually 24 hours after trauma, mainly in men in age range 30-44 years with disorders of consciousness (GCS 11). As the result of operation, the majority of patients (6 out of 7) were discharged as self-independent. The authors reviewed the literature for cavernous haemangioma. The tumour may be present in any region of the brain including infratentorial region. The lesion is disclosed most frequently in children as spontaneous brain haemorrhage and rarely as seizures or intracranial hypertension. Final diagnosis is based on cerebral angiography or MRI. CT-scans are not typical and before the appearance of haematoma do not suggest the presence of tumour. Surgical removal of haematoma with tumour fragments is the main method of therapy, but radiation is possible in order to diminish the mass. The authors conclude that in each patient with post-traumatic intracerebral haematoma, the presence of cavernous haemangioma is possible.     

Granulomatous angiitis of the central nervous system: a case with recurrent intracerebral haemorrhage.

A 43-year-old man with a history of radiculomyelopathy developed recurrent intracerebral haemorrhage confirmed by CT brain scan. Cerebral angiography and systemic investigations showed no underlying cause for the haemorrhage. Cerebral biopsy at the time of evacuation of a haematoma revealed granulomatous angiitis. This condition may be responsive to steroids and should be considered in cases of intracerebral haemorrhage of obscure origin.     

Delayed intracerebral haemorrhage after intracranial surgery.

Intracerebral haemorrhage may occur several hours after intracranial surgery. The exact mechanism by which this occurs is still unclear, although prolonged brain retraction is considered to be the most responsible factor. In these delayed postoperative haematoma cases, serial angiography has never been performed. We performed angiographic evaluation in such 12 cases and, in 5 of them, surgical evacuation of the haematoma was performed because of life-threatening mass effect and the cortical veins and the surrounding cerebral tissues were examined histologically. In all cases, angiographically thrombotic difufse occlusion of the cortical vein(s) without collateral circulation was observed, and histologically there was marked damage to the intima of the vein, remarkable macrophage infiltration into the subadventitial spaces, and extensive red cell extravasation into the subarachnoid space and brain parenchyma from the maximally dilated venules and capillaries. These findings suggest that diffuse intravenous thrombosis induced by cortical vein injury and prolonged brain retraction may be important causes of unexpected delayed postoperative intracerebral haematoma in surgery using the interhemispheric or subtemporal approach.     

Microscopic polyangiitis presenting with peripheral and central neurological manifestations

Although peripheral neuropathy is a common complication of microscopic angiitis, manifestations involving the muscle and the central nervous system have been rarely reported. We describe a 48-year-old man who rapidly developed a clinical picture of mononeuritis multiplex. A month after the appearance of the primary symptoms, he became comatose and had left hemiplegia in relation with a massive cerebral haematoma. Laboratory data revealed signs of inflammation, glomerular dysfunction with microhaematuria, and positive myeloperoxidase-antineutrophil cytoplasmic antibodies. The neuromuscular biopsy disclosed a small-vessel vasculitis, consisting with microscopic angiitis, associated with myositis and extensive axonal loss. The patient had surgical evacuation of the haematoma and received immunosuppressive therapy with good outcome. Thus, microscopic angiitis should be considered as a differential diagnosis in cases of myositis and intracerebral haemorrhage.     

神经内镜下手术治疗高血压幕上脑实质内血肿效果分析

目的探讨神经内镜下清除幕上脑实质内血肿的手术治疗效果。方法回顾性分析我院2015-02-2017-01收治的高血压幕上脑实质内出血且手术清除血肿的64例患者,其中对照组34例在常规直切口显微镜下血肿清除,治疗组30例在内镜下完成。结果对比2组患者手术切口大小、术中出血量、手术时间、术后血肿清除率、平均住院日及平均住院费用。可见治疗组在手术切口长度、术中出血量及手术所用时间优于对照组(P0.05),而2组手术血肿清除率和平均住院时间及平均住院费用方面无明显差异(P0.05),1个月后随访患者ADL无显著差别(P0.05)。结论神经内镜下脑血肿清除术对高血压脑出血幕上血肿的治疗效果,不低于显微镜下微创清除血肿,治疗效果同样确切,值得临床推广应用。