经侧裂-岛叶入路显微手术治疗基底节区高血压脑出血

目的探讨经外侧裂-岛叶入路显微手术治疗基底节区高血压脑出血的临床疗效。方法对32例基底节区高血压脑出血的患者采取额颞部扩大翼点入路切口经外侧裂-岛叶入路清除血肿。结果本组32例患者,术中显露血肿腔良好,在显微镜下血肿清除较彻底,止血效果良好,减压充分。患者出院时按GOS评价治疗效果：恢复良好：14例（43．8％）;中重残：12例（37．5％）;植物生存：2例（6．25％）;死亡：4例（12．5％）。结论经外侧裂-岛叶入路显微手术治疗基底节区高血压脑出血具有创伤小、清除血肿彻底、疗效佳等优点。可以在有条件的基层医院开展。     

经侧裂-岛叶入路显微手术治疗高血压基底节区脑出血

目的 探讨经侧裂-岛叶入路显微手术治疗高血压基底节区脑出血的疗效. 方法 对43例高血压基底节区脑出血患者采用经侧裂-岛叶入路显微手术,充分清除血肿和精确止血,术中注意脑组织和脑血管保护,并根据术前神志及术中脑压情况决定是否去骨瓣减压,破入脑室者术中先行侧脑室穿刺外引流. 结果 31例血肿清除率达到90%,小于80%者4例,介于两者之间8例.术后43例随访6～18个月,依据ADL分级:Ⅰ级8例,Ⅱ级18例,Ⅲ级11例,Ⅳ级5例.死亡1例,死于肺部感染,术后再出血1例. 结论 经侧裂-岛叶入路显微手术是治疗高血压基底节区脑出血有效的微创方法,具有精细彻底清除血肿、对脑组织损伤轻微和有利神经功能恢复等优点.     

高血压性基底节区脑出血的显微手术治疗

目的探讨经侧裂-岛叶入路显微手术治疗高血压性基底节区脑出血的效果。方法2008年8月～2012年8月对25例高血压性基底节区脑出血在显微镜下分离外侧裂,经岛叶无血管区进入血肿腔,行血肿清除术。术后按照严格的内科治疗,控制血压,神经营养,康复治疗,进行ADL评分。结果术后存活24例,死亡1例（4．0％）。24例术后3个月按ADL评分：Ⅱ级13例（54．2％）,Ⅲ级8例（33．3％）,Ⅳ级2例（8．3％）,Ⅴ级1例（4．2％）。结论经侧裂-岛叶人路显微手术治疗高血压性基底节区脑出血创伤小,疗效满意。     

基底节区脑出血经侧裂岛叶入路应用分析

目的探讨基底节区脑出血经侧裂岛叶入路的应用效果。方法回顾性分析2013-12—2015-12间收治的96例基底节区脑出血患者的临床资料,比较不同类型基底节区脑出血经侧裂岛叶入路的手术治疗效果。结果血肿完全清除率90%,住院治疗过程中死亡6例,并发症发生率20.8%,不同类型基底节区脑出血不良事件发生率对比无明显统计学差异(P0.05)。6个月随访过程中,6例死亡。结论经侧裂岛叶入路手术治疗基底节区脑出血,效果满意。     

超早期小骨窗外侧裂入路显微手术治疗高血压性基底节脑出血

目的总结超早期小骨窗外侧裂入路显微手术治疗高血压性基底节脑出血经验。方法2001年3月～2005年2月，我科对33例高血压性基底节脑出血6h内超早期手术，采用小骨窗开颅，经外侧裂、岛叶入路，显微镜下清除血肿，去骨瓣减压，不放引流，术后严格控制高血压。结果术后CT复查血肿清除彻底。术后肺炎2例。按格拉斯哥预后评分标准随访3个月，良好23例，中残10例。结论超早期小骨窗外侧裂入路显微手术治疗高血压性基底节脑出血，具有创伤小，清除血肿彻底，并发症和致残率低，恢复功能快等优点。     

小骨窗开颅经侧裂-岛叶入路显微手术和传统骨瓣开颅手术治疗基底节区脑出血的效果对比

目的 探究小骨窗开颅经侧裂-岛叶入路显微手术和传统骨瓣开颅手术治疗基底节区脑出血的效果。方法 选取我院2017年10月～2018年10月基底节区脑出血患者60例，根据治疗方案不同分组，各30例。传统组给予传统骨瓣开颅手术治疗，小骨窗组给予小骨窗开颅经侧裂-岛叶入路显微手术治疗。对比两组手术情况、格拉斯哥昏迷评分（GCS）（术前、术后1周、术后2周）、巴氏指数（BI）（术后1个月、术后3个月、术后6个月）、并发症。结果 与传统组相比，小骨窗组术中出血量较低，手术时间较短（P<0.05）；小骨窗组术后1周GCS评分较传统组高（P<0.05）；术后1个月、术后3个月小骨窗组BI较传统组高（P<0.05）；小骨窗组并发症发生率3.33%较传统组26.67%低（P<0.05）。结论 与传统骨瓣开颅手术相比，小骨窗开颅经侧裂-岛叶入路显微手术治疗基底节区脑出血，具有创伤小、出血少、手术时间短、并发症少等优势，并可促进患者昏迷恢复，提高日常生活活动能力。     

小骨窗开颅经侧裂-岛叶入路显微手术和传统骨瓣开颅手术治疗基底节区脑出血的效果对比

目的 探究小骨窗开颅经侧裂-岛叶入路显微手术和传统骨瓣开颅手术治疗基底节区脑出血的效果。方法 选取我院2017年10月～2018年10月基底节区脑出血患者60例,根据治疗方案不同分组,各30例。传统组给予传统骨瓣开颅手术治疗,小骨窗组给予小骨窗开颅经侧裂-岛叶入路显微手术治疗。对比两组手术情况、格拉斯哥昏迷评分（GCS）（术前、术后1周、术后2周）、巴氏指数（BI）（术后1个月、术后3个月、术后6个月）、并发症。结果 与传统组相比,小骨窗组术中出血量较低,手术时间较短（P<0.05）;小骨窗组术后1周GCS评分较传统组高（P<0.05）;术后1个月、术后3个月小骨窗组BI较传统组高（P<0.05）;小骨窗组并发症发生率3.33%较传统组26.67%低（P<0.05）。结论 与传统骨瓣开颅手术相比,小骨窗开颅经侧裂-岛叶入路显微手术治疗基底节区脑出血,具有创伤小、出血少、手术时间短、并发症少等优势,并可促进患者昏迷恢复,提高日常生活活动能力。     

翼点入路经岛叶显微手术治疗基底节区高血压脑出血

【摘要】〓目的〓探讨基底节区高血压脑出血显微手术疗效。方法〓回顾性分析23例翼点入路经岛叶显微手术治疗的基底节区高血压脑出血患者的临床资料。 结果〓术后24 h复查头颅CT,血肿清除率 > 90%者21例(91.3%)。术后随访6~36个月,根据日常生活能力分级,Ⅰ级8例,Ⅱ级9例,Ⅲ级3例,Ⅳ级2例。Ⅴ级1例。 结论〓翼点入路经岛叶显微手术治疗基底节区高血压脑出血,血肿清除率高、神经功能恢复较好。     

高血压脑出血小骨窗经外侧裂岛叶入路血肿清除术效果观察

目的观察高血压脑出血小骨窗经外侧裂岛叶入路血肿清除术的效果。方法将收治的120例高血压脑出血患者按照手术方法不同分为2组,各60例。大骨瓣组行大骨瓣开颅血肿清除术,小骨窗组行小骨窗经外侧裂岛叶入路血肿清除术。比较2组术后第1天血肿清除率及术前、术后3个月的SF-36评分。结果小骨窗组术后第1天的血肿清除率,以及3个月的SF-36评分均高于大骨瓣组,差异均有统计学意义(P<0.05)。结论小骨窗经外侧裂岛叶入路血肿清除术治疗高血压脑出血患者,可提高血肿清除率和患者的生活质量,可作为高血压脑出血的重要治疗术式。     

经外侧裂-岛叶入路显微手术治疗基底节区脑出血的临床效果及其对神经因子的影响

目的分析经外侧裂-岛叶入路与经颞叶皮质入路显微手术治疗基底节区脑出血的临床效果及对神经因子的影响。方法 2013年1月～2017年3月我院收治的高血压基底节区脑出血病人130例,随机分为观察组与对照组,观察组接受经外侧裂-岛叶入路显微手术,对照组接受经颞叶皮质入路显微手术,比较两组的手术时间、血肿清除率、日常生活能力以及S-100β蛋白(S-100βprotein,S-100β)、神经元特异性烯醇化酶(neuron specific enolase,NSE)、胶质纤维酸性蛋白(glial fibrillary acidic protein,GFAP)的变化。结果观察组的手术时间比对照组短,差异有统计学意义(P0.05)。观察组的血肿清除率为96.92%,对照组为83.08%,两组比较差异有统计学意义(P0.05)。观察组的日常生活能力优于对照组,差异有统计学意义(P0.05)。手术前,两组病人的S-100β、NSE、GFAP水平比较,差异无统计学意义(P0.05);术后2周,两组病人的S-100β、NSE、GFAP水平均比治疗前下降,观察组的S-100β、NSE、GFAP较对照组更低,差异有统计学意义(P0.05)。结论经外侧裂-岛叶入路显微手术治疗高血压基底节脑出血的临床效果显著,可降低神经损伤因子水平。     

Pterional keyhole approach to middle cerebral artery aneurysms through an outer canthal skin incision.

OBJECT: The supraorbital keyhole approach via an eyebrow skin incision provides a method for the minimally invasive clipping of aneurysms located in the circle of Willis, but has disadvantages for aneurysms located in the lateral Sylvian fissure. The pterional keyhole minicraniotomy via an outer canthal skin incision is proposed for the clipping of unruptured aneurysms of the middle cerebral artery (MCA). METHODS: The procedure consists of a 35-mm outer canthal skin incision, partial temporal muscle dissection restricted in the pterion, a 20-25-mm keyhole minicraniotomy, and a 15-20-mm dural incision to expose the lateral Sylvian fissure. Twenty keyhole clipping procedures were performed in 20 patients with unruptured MCA aneurysms. RESULTS: Only one patient showed a temporary mild hemiparesis (reversible ischemic neurological deficit) due to lacunar infarction. No shaving of scalp hair, drain placement, or anticonvulsant drug administration were required. Most patients were discharged on the 2nd or 3rd postoperative day. One patient showed a weakness of the frontalis muscle, but this complication was eliminated by the definition of a safety zone to avoid damage to the frontal branch of the facial nerve. CONCLUSIONS: The pterional keyhole approach via outer an canthal skin incision is another treatment option for relatively small, unruptured MCA aneurysms.     

Efficacy and safety of the pterional keyhole approach for the treatment of anterior circulation aneurysms

Keyhole surgery is partly replacing the standard pterional approach in patients undergoing surgery to treat aneurysms of the anterior circulation. We describe the pterional keyhole approach for the clipping of anterior circulation aneurysms and discuss the efficacy and safety of our keyhole craniotomy procedure. We treated 103 patients with 111 intracranial aneurysms by surgical clipping via the pterional keyhole approach and retrospectively compared the characteristics and clinical outcomes of the keyhole procedure and the standard pterional approach. We also compared the surgical results of the keyhole approach when the operator was an experienced neurosurgeon or a less experienced neurosurgeon guided by an experienced colleague. All keyhole operations were carried out successfully without enlargement of the craniotomy or a change to a different approach. The outcomes of the keyhole and the standard pterional approach in patients with subarachnoid hemorrhage were not significantly different. Favorable outcomes were obtained in patients with unruptured aneurysms treated by either experienced or less experienced surgeons. The pterional keyhole approach offers the same surgical possibilities as conventional pterional approaches for the treatment of anterior circulation aneurysms. It is safe and simple and yields favorable outcomes even if the operators are less experienced neurosurgeons. Careful patient selection and sufficient opening of the sylvian fissure are the key points for good outcomes and the prevention of intraoperative complications.     

CTA辅助下经侧裂入路高血压壳核出血的显微外科治疗

目的 探讨CTA辅助下经侧裂入路显微外科治疗高血压壳核出血的方法及预后.方法 2004年5月～ 2008年5月间共收治符合显微外科治疗标准的高血压壳核出血病例81例,分为CTA辅助下经侧裂入路血肿清除术组(侧裂组,58例)及经传统的颞上回入路治疗组(颞上回组,23例).通过对CTA辅助下经侧裂入路特点及预后的分析,总结临床经验. 结果 采用KPS评分判定预后,随访半年.侧裂组58例,KPS评分60 ～ 80者15例(25.9％),40～ 50者20例(34.5％),10～ 30者20例(34.5％),评分为0者3例(5.1％).颞上回组23例,KPS评分60～80者1例(4.4％),40～ 50者5例(21.7％),10～30者15例(65.2％),评分为0者2例(8.7％).两组比较差异显著(P＜0.01). 结论 CTA辅助下经侧裂入路显微外科治疗高血压壳核出血安全、有效,预后优于传统的经颞上回入路手术.     

Effect of clot removal on cerebral vasospasm

The effect of clot removal on cerebral vasospasm was studied in 104 patients with aneurysmal subarachnoid hemorrhage (SAH). The series included patients who fulfilled all of the following criteria: operation was performed by Day 3 after the ictus; the patient's preoperative clinical grade was between Grades I and IV; there was no rebleeding; computerized tomography (CT) showed only SAH; and carotid angiograms were performed by Day 2 and repeated between Days 7 and 9. Both the degree of SAH on CT and angiographic vasospasm were graded from 0 to III. The relationship of the SAH grade in the basal frontal interhemispheric fissure (IHF) to the presence of vasospasm at the A2 segments of the anterior cerebral artery and the relationship of the SAH grade in the sylvian stems to the presence of vasospasm at the M1 segments of the middle cerebral artery were analyzed. Correlation of preoperative and postoperative SAH grades with the angiographic vasospasm grades, with the incidence of symptomatic vasospasm, and with the low-density area on CT could be found in the A2 and M1 territories. Decrease of cisternal blood measured by CT after the operation did not relate directly to the reduction of vasospasm. When the SAH was Grade II or III in the basal frontal IHF, the angiographic vasospasm grades at the A2 were significantly lower in patients with surgery via the interhemispheric approach than in those with surgery via the pterional approach. Symptomatic vasospasm occurred in two of the eight cases operated on by the interhemispheric approach compared with 11 of the 22 cases approached via the pterional route. In patients with a pterional approach, there was no significant difference in severity of vasospasm in the M1 territory between the side of approach and the opposite side. No consistent relationship could be found between the time interval from SAH to operation and the severity of vasospasm. While clot removal may ameliorate cerebral vasospasm, its effect per se does not seem to be significant.     

小骨窗开颅显微手术治疗基底节高血压脑出血

目的探讨小骨窗开颅微创治疗基底节高血压脑出血的临床疗效。方法对138例基底节区高血压脑出血患者采用小骨窗开颅,显微镜下清除血肿。结果术后24h内复查CT显示,117例血肿清除90%以上,21例血肿清除80%以上。死亡13例,其中5例死于术后再出血所致的脑疝,3例死于肺部感染,2例死于多器官衰竭,死于颅内感染、气道梗阻及消化道大出血各1例。术后生存125例,平均随访8(3～12)个月,日常生活能力(ADL)分级:Ⅰ级25例,Ⅱ级49例,Ⅲ级34例,Ⅳ级15例,Ⅴ级2例。结论小骨窗开颅显微手术创伤小,术野显露充分,血肿清除彻底,止血可靠,是治疗基底节高血压脑出血的有效手术方式之一。     

Minimally invasive keyhole approach for removal of a migratory balloon complicated by endovascular embolization of a carotid-cavernous fistula.

PURPOSE: This report presents our experience in using a minimally invasive keyhole approach to remove a migratory balloon in the cerebral artery in one patient. CASE REPORT: A 19-year-old male suffered from carotid-cavernous fistula after craniofacial trauma two months previously. The patient received endovascular embolization of a carotid-cavernous fistula with detachable balloons. Unfortunately, migration of one balloon to the right middle cerebral artery (MCA) at the M1-M2 junction was noted after detaching the balloon during this procedure. Volume expansion, anticoagulation therapy and an emergency pterional keyhole approach with removal of the displaced balloon were performed successfully. Transient left hemiparesis due to temporary occlusion of the right middle cerebral artery by the balloon was promptly alleviated. There was no definite neurological sequel after the operation. CONCLUSIONS: Although detachable balloon embolization is the best initial treatment of direct carotid-cavernous fistulas, it is likely to migrate to downstream cerebral arteries. We recommend a minimally invasive pterional keyhole approach as a good alternative for treating such endovascular complications to improve outcome.     

外侧裂区胶质瘤的解剖特点及显微手术探讨

目的探讨外侧裂区胶质瘤的解剖特点、影像学特征以及显微手术方法。方法回顾性分析46例外侧裂区胶质瘤患者临床资料,其中行肿瘤全切除30例,次全切除13例,部分切除3例。结果病理证实星形细胞瘤29例,多形性胶质母细胞瘤7例,少支胶质瘤10例。术后对侧肌力好转15例,加重4例。脑血管痉挛8例(致重度脑水肿6例),其中7例对症治疗后预后良好,1例脑梗塞致重残。暂时性失语和记忆减退4例。无手术死亡病例。41例平均随访18(3～36)月,35例存活,6例死亡(5例死于肿瘤复发,1例死于肺部感染)。12例平均于术后14(10～18)月复发。结论经外侧裂显微手术切除胶质瘤可显著提高肿瘤近全切率,减少术后神经功能障碍并发症,避免短期肿瘤复发。恰当的手术入路,对侧裂区动静脉及重要功能区的精确辨认和保护是提高疗效的关键。     

锁孔入路显微手术的临床应用

目的探讨锁孔入路显微手术在神经外科的应用. 方法采用相应锁孔入路对鞍区占位13例,脑膜瘤6例,高血压性脑出血5例,胼胝体区胶质瘤2例,听神经瘤2例,脑转移瘤、硬膜外血肿和C2椎管内占位各1例实施手术. 结果 25例肿瘤全切19例,次全切除6例;脑出血5例和硬膜外血肿1例均彻底清除.1例听神经瘤术后第3天因瘤腔再次出血死亡,切口下皮下积液2例,一过性尿崩3例. 结论锁孔手术具有脑暴露少,损伤小,并发症少,恢复快等优点.