小骨窗经侧裂显微手术治疗老年高血压基底节区血肿36例疗效观察

目的探讨小骨窗经侧裂入路显微手术治疗老年高血压基底节区出血的技术要点及临床疗效。方法对眉山市人民医院收治的36例经CT证实血肿量为30～80 ml且未出现脑疝症状的高血压性基底节区出血(hypertensive basal gangli-a hemorrhage,HBGH)老年患者,行翼点小骨窗开颅经外侧裂岛叶入路显微镜下血肿清除术。结果术后12小时内CT复查血肿清除达80%以上29例,50%～80%6例;术后再出血1例,出血量≤20 ml。死亡3例(8.3%);存活病例术后6月按照日常生活能力(ADL)评价,自理8例(24.2%),部分自理12例(36.4%),中度依赖10例(30.3%),完全依赖3例(9.1%)。结论小骨窗开颅经外侧裂岛叶入路显微手术治疗HBGH具有微创、手术时间短、术后恢复良好等优点。

Observation of curative effect of small skull window removal of 36 cases elderly hypertensive intracerebral hematoma via transsylvian approach

Objective To explore the efficacy and operative technique of microsurgery transsyvian approach for hypertensive basal ganglia hemotoma （HBGH）. Methods 36 elderly patients hospitalized in the People＇s Hospital of Meishang City with HBGH were diagnosed by CT scan. All patients had not cerebral hernia and the volume of hematoma was 30-80 ml. Microsurgery was performed to remove the hematomas transpterion-syvian approach through small skull window. Results The CT re-examination within postopera- tive 12 hr showed that the hematomas were removed over 80% in 29 eases,between 50% -80% in 7 eases. And postoperative rebleed- ing（ 〈20 mL） occurred in lease. The mortality of this group was 8.3%. In 6 months post-operative follow-up,the ADL scale of the sur- vival eases was ： 8 eases were self-care （ 24. 2% ）, 12 cases were part of self-care （ 36.4% ） , 10 eases were moderately dependent （30. 3% ） and 3 eases were completely dependent （9. 1% ）. Conclusion With proper ease selection, microsurgery transsylvian ap- proach is a minimally invasive method with little damage, good exposure, comparatively complete hematoma removal, desirable effect of decompressing the intracerebral pressure and favorable recovery of neural function.