CT引导立体定向神经内镜手术治疗高血压性脑出血

目的探讨CT引导立体定向神经内镜手术治疗高血压脑出血的方法和疗效。方法局麻下安装ASA601S型立体定向仪,CT扫描选择血肿最大层面为中心靶点测量坐标,设计手术切口和入路,全麻下环钻开颅,颅骨钻孔直径3 cm,导针穿刺放置导管引导,沿非功能区皮层径路到达血肿腔,应用神经内镜清除血肿,电凝出血点。结果按28例脑实质内出血血肿清除50%者3例,50%～70%者12例,70%～90%者13例；5例伴有出血破入脑室内者,清除均在90%以上；术后7 d死亡2例,未发现术后再出血。随访6月显著好转和好转20例,无变化4例,恶化2例。结论应用立体定向神经内镜清除脑内血肿,是一种定位精确、微创、安全、血肿清除率较高和疗效较好的治疗方法。

CT-guided Stereotactic and Neuroendoscope-assisted Surgery for Hypertensive Intracerebral Hemorrhage

Objective To evaluate the curative effect of CT-guided and stereotactie neuroendoscope-assisted operation on intracerebral hematoma caused by hypertension.Methods Twenty-eight patients with hypertensive cerebral hemorrhage were examined by CT scan.Intracranial hematomas were removed and the ruptured arteries were coagulated by CT-guideed stereotaetic and rigid neuroendoscope-assisted surgery.Results Of 28 patients with intracerebral hematomas,3 received evacuation of 50% of hematomas,12 did 50%-70% and 13 did 70%-90%.The evacuation of more than 90% of intraventricular hematomas was achieved in 5 patients with intracerehral hematomas going into the ventricles.Two patients died within 7 days after the operation.The following up for 6 months after the operation,in 26 patients showed that the curative effects were excellent or good in 20 patients,moderate disability occurred in 4 and the conditions of 2 patients deteriorated.Conclusion CT-guided stereotactic and neuroendoscope-assisted surgery is a safe effective and minimally invasive method for evacuation of the intracerebral hematoma induced by hypertensive hemorrhage.