脑内血肿立体定向排空术

目的为了治疗高血压脑出血,应用CT引导脑立体定向仪脑内血肿排空术.方法采用日本驹井式脑立定仪向在CT引导下,对12例高血压脑出血病人施行立体定向脑内血肿排空术.结果11例术后经过良好,神经功能障碍均在术后早期得到恢复.结论CT引导立体定向脑内血肿排空术,操作简便、定位准确、创伤小、手术时间短、疗效肯定,是降低高血压脑出血死亡率、致残率、提高生存质量的有效方法.     

“无创CT脑立体定向仪”在治疗高血压脑出血中的临床应用

目的总结分析无创CT脑立体定向仪,在高血压脑出血立体定向手术治疗中的手术指征、方法和临床价值.方法使用自制无创CT脑立体定向仪行高血压脑出血立体定向手术78例,采用立体定向穿刺部分清除血肿、置管尿激酶溶解引流的方法.结果78例无创CT脑立体定向手术病人,总死亡率7.6%.结论使用无创CT脑立体定向仪行高血压脑出血立体定向手术治疗,是一种安全、快速、使用方便、方法简单、创伤小、疗效好的治疗方法.     

ROSA辅助治疗高血压脑出血的优越性及可行性研究

目的对比立体定向手术机器人(Robot of Stereotactic Assistant,ROSA)辅助与框架立体定向辅助脑内血肿钻孔引流术治疗高血压性脑出血的疗效。方法回顾性分析146例高血压脑出血病例资料,均采用血肿钻孔引流术治疗,根据时间节点分为框架辅助组58例(2015年8月-2016年4月)和ROSA辅助组88例(2016年5月-11月)。结果框架辅助组手术时间(48.02±7.68)min,ROSA辅助组(30.13±8.72)min。框架辅助组术后再出血率为10.3%(6/58),ROSA辅助组为1.1%(1/88)。框架辅助组术后拔管时间(3.64±0.87)d,ROSA辅助组(1.12±0.36)d。ROSA辅助组在手术时间、术后再出血率、术后拔管时间均优于框架辅助组(均P0.05)。结论 ROSA辅助脑内血肿钻孔引流术治疗高血压性脑出血,能够有效减少手术时间、术后再出血率及术后拔管时间,减轻病人负担,值得临床推广。     

立体定向与开颅手术治疗高血压脑出血的疗效观察

目的比较立体定向血肿排空加尿激酶溶凝块与开颅脑内血肿清除术治疗高血压脑出血的临床疗效。方法将2005年5月～2008年2月间收治的高血压脑出血患者160例分为立体定向血肿排空术加尿激酶溶凝块组和开颅血肿清除组,比较两种手术对患者预后的影响。结果术后1周立体定向血肿排空术加尿激酶溶凝块组GCS评分及肌力提高水平明显优于开颅血肿清除组(P<0.01),随访6月,治疗组功能恢复良好(ADLⅠ～Ⅲ)率及残死(ADLⅣ～Ⅴ)率与对照组无差异(P>0.05)。结论立体定向血肿排空术加尿激酶溶凝块治疗高血压脑出血能在短期内明显提高疗效,但远期疗效二者无差异。     

尿激酶辅助立体定向术治疗高血压脑出血

目的探讨尿激酶辅助立体定向术治疗高血压脑出血的临床应用价值。方法对30例高血压脑出血患者(定向组)采取立体定向血肿次全排空术,术中血肿腔置管,术后残留血肿采取尿激酶溶解。以拔管时间及日常生活能力(ADL)评分作为评价疗效的指标,与同期采取CT定位下钻孔抽吸血肿及尿激酶溶解术(抽吸组)的30例患者进行比较。结果定向组拔管时间明显短于抽吸组,疗效明显好于抽吸组。结论尿激酶辅助立体定向术治疗高血压脑出血具有创伤小、操作简便、清除血肿较彻底等优点,是治疗高血压脑出血的一种有效方法。     

立体定向手术治疗高血压脑出血20例

目的探讨立体定向术治疗高血压脑出血的疗效.方法应用南京麦迪柯科技有限公司生产的3C98-2型双向结合脑立体定向仪,在局麻下安装立体定向框架,进行CT扫描,直接测量并得出三维坐标数值,将数据输入立体定向计划系统,以血肿中心为靶点坐标,置人引流管,每12小时注入2万单位尿激酶,同时配合脱水止血,引流出血液明显变淡后停止注入尿激酶,根据复查头颅CT,决定拔管.结果术后10天CT复查,基本无残余血,本组死亡2例,死于再出血,ADL分级1～2级12例,3～4级6例.结论立体定向血肿穿刺引流术治疗高血压脑出血具有损伤小,安全性高,定位准确的优点,手术时期应选择在出血后6～24小时为宜.     

自制简易脑立体定向仪辅助神经内镜治疗基底节区 脑出血的疗效分析

目的 探讨自制简易脑立体定向仪辅助神经内镜治疗基底节区脑出血的疗效。方法 回 顾性收集 2019 年 1 月至 2020 年 12 月南京市浦口区中心医院收治的 40 例高血压基底节区脑出血患者的 手术资料,按手术方式分为观察组（22 例）和对照组（18 例）,观察组采用简易脑立体定向仪辅助内镜下血 肿清除术,对照组采用常规骨瓣开颅血肿清除术。比较两组患者术前一般资料、手术时间、术中出血量、 血肿清除率、术后并发症发生率,采用扩展格拉斯哥预后评分（GOS-E）比较两组患者术后 3 个月 GOS-E 良好率。结果 观察组手术时间短于对照组［（65.8±10.5）min 比（125.3±20.4）min］、术中出血量少于 对照组［（50.2±10.6）ml 比（295.3±18.5）ml］、血肿清除率高于对照组［（88.2±3.8）% 比（70.3±5.6）%］,差 异均有统计学意义（均P＜ 0.05）。观察组患者术后 3 个月 GOS-E 良好率为 72.7%（16/22）,高于对照组的 7/18,差异有统计学意义（P＜0.05）。观察组患者术后并发症发生率为13.6%（3/22）,与对照组的3/18比较, 差异无统计学意义（P＞ 0.05）。结论 相较于常规开颅血肿清除术,自制简易脑立体定向仪辅助神经内 镜治疗高血压基底节区脑出血的手术,能缩短手术时间,术中出血量少,血肿清除率高,能够改善患者 近期预后。     

立体定向手术治疗高血压脑出血的临床评价

目的评价立体定向穿刺引流术治疗高血压脑出血的临床疗效。方法回顾性分析我院233例高血压脑出血患者的临床资料,其中CT引导下行立体定向手术46例,根据CT定位徒手行颅骨钻孔引流术122例,保守治疗65例。结果保守治疗组患者的血肿吸收和住院时间均显著较长(P<0.05),恢复率(41.5%)则明显低于立体定向组(84.8%)和徒手穿刺组(70.5%),术后日常生活能力评分(ADL)亦最差(P<0.05)。立体定向组和徒手穿刺组的术后恢复时间、死亡率和ADL评分无显著差异,但徒手穿刺组的病残率(22.1%)显著高于立体定向组(8.7%)(P<0.05)。各组患者的复发率和并发症率均无显著差异(P>0.05)。结论尽早实施穿刺引流术对于降低高血压性脑出血患者的残死率具有积极意义。立体定向技术可明显提高穿刺的准确性,减少脑部损伤,从而提高恢复率,改善预后。     

立体定向仪指引下微创穿刺引流术治疗高血压脑出血的效果观察

目的观察立体定向仪指引下微创穿刺引流术治疗高血压脑出血的临床效果。方法选取茂名市人民医院2017-01-2018-09收治的100例高血压脑出血患者为研究对象,依据治疗方法不同分为立体定向仪指引下微创穿刺引流术治疗组(观察组)及经颞硬通道微创穿刺引流术治疗组(对照组),每组50例。对比2组治疗前后神经功能缺损程度及生活质量情况,对比血肿清除情况、疗效以及并发症情况。结果 2组神经功能缺损评分在经治疗后的3个月均显著降低(P0.05),ADL评分治疗后均显著升高(P0.05);治疗后观察组神经功能缺损评分显著低于对照组,ADL评分显著高于对照组,治疗总有效率显著高于对照组(P0.05)。结论行立体定向仪指引下微创穿刺引流术治疗高血压脑出血治愈率相对较高,疗效较好,术后并发症少,操作便捷简单,是一种实用性较高的微创手术治疗方式。     

立体定向多靶点置管抽吸引流术治疗深部高血压脑出血

目的回顾性分析立体定向多靶点置管抽吸引流术治疗深部高血压脑出血患者的疗效,验证其有效性和可行性。方法68例高血压脑出血随机分为A组和B组,A组38例,采用立体定向多靶点置管抽吸引流技术治疗;B组30例,采用常规立体定向单靶点技术置管抽吸引流。两组分别进行术后3天的血肿排空率、置管引流时间及其GOS评分的差异比较。结果A组患者置管时间2~5天,平均3.5±1.5天,3天平均血肿排空率90.8%。B组置管引流时间为5~9天,平均7.5±2.1天,3天平均血肿排空率68.8%。A组的置管引流时间和血肿排空率明显好于B组。结论立体定向多靶点置管抽吸引流术治疗深部高血压脑出血具有血肿排空彻底,缩短病程,减少并发症,尤其适合于血肿量较大、血肿形态不规则或破入脑室的颅内血肿。     

显微血管减压术后颅内出血的原因及应对策略

目的 探讨显微血管减压(MVD)术后颅内出血的原因及应对策略.方法 对12例面肌痉挛、三叉神经痛MVD术后颅内出血患者的临床资料进行回顾性分析,并对相关文献进行复习.结果 本组患者中,小脑半球实质内血肿者3例,小脑出血破入脑室3例,蛛网膜下腔出血2例,脑室出血2例,后颅窝硬膜外血肿1例,幕上硬膜下血肿1例.1例脑室出血...     

神经导航辅助微侵袭技术在老年小脑出血患者中的应用

目的通过神经导航辅助下微侵袭技术在老年患者小脑出血中的应用,探讨其实用价值。方法小脑出血的患者(≥60岁),通过神经导航辅助下钻孔血肿外引流术患者为实验组,通过开颅血肿清除手术患者为对照组,对两组患者预后(ADL评级)进行统计学分析。结果神经导航辅助下钻孔血肿外引流术与开颅血肿清除术在老年小脑出血患者预后及术后并发症上有统计学意义(P0.05)。结论应用神经导航辅助下微侵袭穿刺置管治疗老年小脑出血,有利于减少术后并发症,改善预后,对临床神经外科医生有一定的指导作用和积极地临床意义,值得借鉴。     

应用简化增强现实技术辅助定位引流术治疗老年幕上脑出血的临床研究

目的 通过对比分析评价利用智能手机简化增强现实(AR)技术辅助定位引流术治疗老年幕上脑出血的应用价值.方法 回顾性分析221例引流手术治疗的老年幕上脑出血患者(出血量20～ 40 mL)的临床资料,其中行简化AR技术辅助定位引流术(观察组)108例,行立体定向引流术(对照组)113例.对比两组患者手术时间,置管位置准确...     

CT辅助下立体定向穿刺引流术治疗基底节区脑出血的疗效分析

目的探讨CT辅助下立体定向穿刺引流术治疗老年高血压基底节区脑出血的疗效及其并发症。方法将发病24 h内的80例老年高血压脑出血患者分为穿刺引流术组和对照组。两组患者分别采用CT辅助下立体定向穿刺引流术和药物保守治疗;观察比较两组患者的住院治疗时间、并发症、治疗后的神经功能恢复,以及治疗前、后的神经功能评分。结果引流术组患者的并发症发生率为12.5%,对照组则为32.5%。引流术组的住院时间(17.6 d)、最终NIHSS评分(3.28分)和总有效率(92.5%)均明显优于对照组(24.6 d,4.00分和77.5%)。结论 CT辅助下立体定向穿刺引流术治疗基底节区脑出血创伤小,可以明显减少各种并发症,缩短患者的住院时间减少花费。与保守治疗相比,能促进患者神经功能的早期恢复。     

简易经额定向穿刺术治疗高血压基底节区脑出血的研究

目的探讨简易经额定向穿刺术治疗高血压基底节区脑出血的效果。方法自2012年10月~2015年6月采用简易经额定向穿刺术治疗高血压基底节区脑出血患者37例,总结分析患者术前临床资料、术中情况及术后疗效。结果本组患者中合并脑疝7例(19%),超早期手术13例(35%);术中平均血肿抽吸率为32%(10%~65%),血肿部分抽吸后见脑皮质塌陷;术后并发症的发生率为22%,其中再出血率5%;术后30 d内的死亡率为0,术后6个月的预后良好率为92%(ADLⅠ~Ⅲ级)。结论简易经额定向穿刺术治疗高血压基底节区脑出血简单实用,适应证广,安全有效;而把握好手术时机和注重围手术期细节管理是疗效好的保障。     

Clinical and radiographic factors involved in achieving a hematoma evacuation rate of more than 70% through minimally invasive catheter drainage for spontaneous intracerebral hemorrhage

Although stereotactic or neuronavigation-guided hematoma drainage for spontaneous intracerebral hemorrhage (ICH) is widely used, its clinical efficacy and factors for predictive results remain to be fully elucidated. This study sought to determine the efficacy of hematoma evacuation for spontaneous ICH, in addition to the factors affecting it. We retrospectively reviewed patients who underwent stereotactic or neuronavigation-guided catheter insertion for spontaneous ICH at our institute between April 2010 and December 2019. We identified and compared the clinical and radiographic factors between groups according to the hematoma evacuation rate of 70%. Logistic regression analyses were performed to identify factors affecting hematoma evacuation. We investigated whether the hematoma evacuation rate was associated with patient survival. A total of 95 patients who underwent stereotactic or neuronavigation-guided catheter insertion and hematoma drainage for spontaneous ICH were included. A multivariate analysis indicated that a hematoma volume of 30–60 cm³ (odds ratio [OR] = 8.064, 95% confidence interval [CI] = 2.285–28.468, P = 0.001), blend sign (OR = 6.790, 95% CI = 1.239–37.210, P = 0.027), diabetes (OR = 0.188, 95% CI = 0.041–0.870, P = 0.032), and leukocytosis (OR = 3.061, 95% CI = 1.094–8.563, P = 0.033) were significantly associated with a higher hematoma evacuation. The mean hematoma evacuation rate in patients with 1-month mortality was lower than that in survivors (P = 0.051). Our study revealed that a hematoma volume of 30–60 cm³, the presence of a blend sign and leukocytosis, and the absence of diabetes are independent predictors that affect more than 70% of hematoma evacuations.     

幕上高血压性脑出血微创颅内血肿抽吸引流术1年预后相关因素分析

目的 探讨幕上高血压性脑出血（intracerebral h emorrhage,ICH）微创颅内血肿抽吸引流术1年预后及其相关因素。      

Intraoperative imaging reveals spot sign with surgical correlate during early endoscopic ICH evacuation

Intracerebral hemorrhage (ICH) is the most devastating form of stroke. Intraoperative imaging and management of intracavity bleeding during early endoscopic ICH evacuation may mitigate rebleeding, hematoma expansion, and neurological worsening. Here we document a case of intraoperative spot sign, detected in the angio suite using cone beam CT with contrast protocol, in a patient with spontaneous supratentorial ICH undergoing evacuation 13 hours after last known well. The spot sign was detected after endoscopic evaluation of the evacuated hematoma cavity demonstrated sufficient hemostasis, but before completion of the case and skin closure, prompting second-pass hematoma evacuation as well as identification and cauterization of the specific correlating bleeding vessel, resulting in near-complete evacuation of the hematoma. Spot sign detection on intraoperative cone beam CT followed by endoscopic ICH evacuation may provide an opportunity to specifically target and treat active bleeding and mitigate impending expansion and neurologic worsening, especially in high-risk patients, including those undergoing early ICH evacuation.     

Surgery for patients with severe supratentorial intracerebral hemorrhage

Introduction  Little information is available on the efficacy of aggressive treatment such as surgery in improving the outcome of severely affected patients after supratentorial intracerebral hemorrhage (ICH). Our objective was to assess the effect of hematoma removal and ventricular drainage on the mortality of patients with severe primary supratentorial ICH. Methods  We studied 103 consecutive patients who were admitted to the intensive care unit and diagnosed with primary supratentorial ICH. The impacts of clinical factors on 30-day mortality were assessed, including surgery, Glasgow Coma Scale (GCS) score and pupillary abnormality at admission, hematoma volume, and other related factors. Results  The 30-day mortality rate was 42%, and the median time between admission and death was 3 days (range: 1 to 27 days). Hematoma removal and ventricular drainage, within the first 24 hours of admission, were performed on 11 and 17 patients, respectively. Two patients who were treated with removal and four with drainage died. A logistic regression model for predicting 30-day mortality was performed. After controlling for GCS score, pupillary abnormality, hydrocephalus, and hematoma volume, hematoma removal was identified as an independent predictor of survival (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.02 to 0.92). Ventricular drainage also tended to decrease mortality rate greatly (OR, 0.31; 95% CI, 0.06 to 1.76). Patients with GCS scores of 3 or 4 were 4.01 times more likely to die (95% CI, 1.13 to 14.26) than those with GCS of at least 5. Conclusions  Hematoma removal may reduce the mortality rate of patients with severe supratentorial ICH.     

Frameless stereotactic aspiration and thrombolysis of deep intracerebral hemorrhage is associated with reduction of hemorrhage volume and neurological improvement

Introduction: This ia a phase-2 safety trial to demonstrate the ability of frameless stereotactic aspiration and thrombolysis of ICH to safely remove blood. Methods: Patients with ICH in the deep basal ganglia and internal capsule of >5 cc volume were consented to undergo computed tomographic imaging for frameless stereotactic guidance registration. Using the frameless stereotactic (CT) guidance, a 4-mm diameter catheter was inserted into the body of the hematoma using a frontal burr hole approach. The catheter was aspirated and then flushed with saline and aspirated to remove unclotted blood. After a confirmatory CT scan to localize the catheter, 1 mg of recombinant tissue plasminogen activator (t-PA) was infused into the clot, permitted to bathe the clot for 30 minutes, and then drained into a closed circuit collection system. t-PA was infused every 8 hours for 48 hours. A follow up CT scan was obtained at 48 hours. Results: 28 patients with ICH (mean age 67.1) were admitted and underwent the procedure. Mean initial ICH volume was 54.6 cc ± 37.8. Mean time from onset to aspiration was 44 hours (range 7–180). Mean initial NIH Stroke scale (NIHSS) score was 24 (range 15–33). Compared with initial CT scan, there was a mean reduction of ICH volume by 77 ± 13% on final CT scan (p<0.0002). Compared with initial NIHSS, the discharge mean NIHSS (16 ± 6) was significantly improved (p<0.001). There were no infectious, hemodynamic or neurologic complications. There were no episodes of symptomatic hemorrhagic enlargement and one case of asymptomatic bleeding along the catheter tract. Conclusion: Frameless stereotactic aspiration and thrombolysis (FAST) of deep spontaneous intracerebral hemorrhage is a safe therapy that is associated with reduction in ICH volume, early improvement in NIHSS and potentially could be used to improve outcome.