显微神经外科手术后并发远隔部位颅内血肿临床分析

目的探讨显微神经外科手术后并发远隔部位颅内血肿的形成原因,以提高对这一并发症的认识和预防。方法复习我科近10年来显微神经外科手术后并发远隔部位颅内血肿的9例病例资料,并进行分析归纳,总结其原因。结果病例远隔部位颅内血肿发生在术后5￣21h,7例病人血肿位于额颞部,硬膜外血肿6例,有7例血肿量超过30mL,均再次手术清除。治疗后1例痊愈,3例死亡,其余遗留一定的功能障碍。结论远隔部位颅内血肿多发生在术后24h内,死亡率致残率高,大部分病例血肿位于额颞顶部,与颅内压急剧下降、手术体位及静脉回流受阻等有关。术中术后采取相应的措施、术后严密监护、早期诊断是防治术后远隔部位颅内血肿的关键。

Clinical analysis of intracranial hematoma remote from site of craniotomy after microneurosurgical operation

Objective To explore the causes of intracranial hematomas remote from the site of craniotomy after microneurosurgical operation, and to know more about the complication and to prevent it effectively. Methods The clinical data of 9 patients with remote intracranial hematoma after microneurosurgical operation from 1996 to 2006 were reviewed and analyzed retrospectively, and the causes were summarized. Results In the 9 cases, remote intracranial hematoma occurred 5~21 h after operation. The hematomas were located at frontal temporal regions in 7 patients, and epidural hematomas were found in 6. In 7 cases, The hematomas' volume was more than 30 mL. All patients were operated again for removing the hematomas. Later, 1 case recovered fully, 3 died and the others were left disabled. Conclusion The complication happens mostly within 24 h after operation and commonly leads to high morbidity and mortality. The hematomas were mostly located at frontal temporal regions and the volume was great. They were associated with quick decrease of intracranial pressure, operative position and venous drainage obstruction. The key points of prevention and treatment included the active protective measures during and after operation, intensive care following operation, and earlier diagnosis.