立体定向抽吸引流术治疗大面积脑叶出血和脑疝

43岁男性,诊断为占位性左侧枕叶出血,血肿破入整个脑室系统.入院时处于深昏迷状态,有脑疝的临床体征,Glasgow昏迷量表评分4分.由于患者年龄较轻且无高血压史,因此高度怀疑存在血管畸形.鉴于患者存在生命危险,医生建议将开颅和血肿清除术作为首选治疗方案,但被其家属以非医疗原因拒绝.为挽救患者的生命,决定行立体定向抽吸术,并得到患者家属认可.在操作过程中和操作后5d内应用了大剂量尿激酶(50000 IU)治疗.1个月后,该患者转归良好,Glasgow转归量表评分为5分.

Stereotactic Aspiration and Drainage on a Patient with Large Lobar Hemorrhage and Brain Herniation A Case Report

A 43-year-old man was diagnosed as massive left occipital lobe hemorrhage with the hematoma expanded into the entire ventricular system. On admission, he was in deep coma with clinical signs of brain herniation and a Glasgow Coma Scale (GCS) score of 4. Vascular malformations were highly suspected since he was young with no history of hypertension. Considering the life-threatening situation, open craniotomy and hematoma evacuation was proposed as the first therapeutic option, but this was refused by his family members for non-medical reasons. In order to save his life, stereotactic aspiration was suggested again and was accepted. UK at an aggressive dosage of 50 000 IU was administered during and after the surgical procedure for 5 days. One month later, this patient gained an excellent recovery with a Glasgow Outcome Scale (GOS) score of 5.