Endoscopic burr hole evacuation of an acute subdural hematoma

Acute subdural hematoma evacuations frequently necessitate large craniotomies with extended operative times and high relative blood loss, which can lead to additional morbidity for the patient. While endoscopic minimally invasive approaches to chronic subdural collections have been successfully demonstrated, this technique has not previously been applied to acute subdural hematomas. The authors report their experience with an 87-year-old patient presenting with a large acute right-sided subdural hematoma successfully evacuated via an endoscopic minimally invasive technique. The operative approach is outlined, and the literature on endoscopic subdural collection evacuation reviewed.     

钻孔闭式引流和YL-1型穿刺针引流治疗慢性硬膜下血肿的疗效观察

目的比较钻孔闭式引流和YL—1型穿刺针引流在治疗慢性硬膜下血肿(CSDH)的疗效。方法回顾分析了我院收治的62例CSDH病人,45例行钻孔闭式引流术(甲组),17例行YL—1型穿刺针引流术(乙组),比较两组治疗效果。结果甲组复发率为6.5％,并发症率为4.1％,乙组复发率为27.7％,并发症率为22.2％。结论钻孔闭式引流较YL-1型穿刺针引流可明显减少CSDH复发率和并发症发生率。     

改良单孔引流治疗慢性硬膜下血肿67例体会

目的 探讨改良单孔引流术治疗慢性硬膜下血肿的可行性、实用性、有效性.方法 回顾性分析我科2004-03～2008-09 67例慢性硬膜下血肿采用改良单孔引流术治疗患者的临床资料.结果 67例患者经治疗后病情皆即明显改善,临床症状逐渐消失,随访1～1.5年,仅2例遗留少量硬膜下积液,无需特殊治疗,1年后自愈,其余病人预后良好,无复发.结论 采用改良单孔引流的手术方法 治疗慢性硬膜下血肿手术方法 简单,可降低传统单孔引流手术方式的诸多并发症,是一种有推广价值的手术方法.     

术中窦汇区迟发性硬膜外血肿致急性脑膨出的治疗

目的 探讨颅脑损伤患者术中窦汇区迟发性硬膜外血肿所致急性脑膨出的临床特点及诊治经验.方法 回顾我院2007年5月至2009年5月收治的10例颅脑损伤患者,均为开颅术中发现急性脑膨出,术中复查头颅CT明确窦汇区迟发性硬膜外血肿的诊断后,取顶枕部"U"形切口,做窦汇区骨瓣成形加自体筋膜加压修补术.结果 根据GOS评分判断愈后:中残2例,重残1例,植物生存1例,死亡6例.结论 窦汇区硬膜外血肿做跨窦骨瓣成形术,骨瓣足够大,出血点完全暴露,再用自体筋膜加压修补术彻底止血,是理想的手术方法 .早期诊断及正确的手术方法 是救治成功的关键.     

颅脑损伤多发性颅内血肿的临床研究

目的探讨颅脑外伤后多发性颅内血肿的临床特点、早期诊断及防治措施。方法回顾性分析152例外伤性多发性颅内血肿的病例资料。GCS 13-15分25例,9-12分46例,6-8分39例,3-5分42例。结果手术123例,非手术29例。随访12周,GOS5分（恢复良好）93例（61.2%）,4分（轻残）18例（11.8%）,3分（重残）22例（14.5%）,2分（植物状态）7例（4.6%）,1分（死亡）12例（7.9%）。死亡原因为多器官功能衰竭、脑干功能衰竭、颅内感染和肺部感染等。结论提高诊断意识、加强临床监测和动态CT扫描有助于多发性颅内血肿的早期诊断和治疗,并改善预后。     

经外侧裂-岛叶入路显微外科治疗基底节区高血压脑出血

目的探讨经外侧裂-岛叶入路显微外科治疗基底节区高血压脑出血的疗效。方法回顾分析12例高血压基底节区脑内血肿患者在急性期接受经外侧裂-岛叶入路显微手术治疗。结果术后即刻复查CT示10例血肿基本清除,2例清除约70%。随访3个月时GOS评分:恢复良好8例,轻度残疾3,重度残疾1例,本组无植物生存及死亡病例。结论经外侧裂-岛叶入路显微外科治疗基底节区高血压脑出血具有微创的特点,能有效清除脑内血肿,并减少了颞叶皮层及血管的损伤,有益于改善患者的预后。     

苯磺酸左旋氨氯地平联合硝酸甘油治疗高血压性脑出血术后病人的临床观察

目的：研究苯磺酸左旋氨氯地平联合硝酸甘油治疗高血压性脑出血术后病人的疗效和安全性。方法：40例高血压性脑出血术后患者随机分成研究组和对照组,各20例。研究组苯磺酸左旋氨氯地平联合硝酸甘油控制血压,对照组采用硝酸甘油治疗。结果：两组患者肝功、肾功、血糖及甘油三酯无明显影响,不良反应相似。与对照组比较,研究组心率无明显变化,硝酸甘油用量明显减少。结论：苯磺酸左旋氨氧地平联合硝酸甘油治疗高血压性脑出血术后病人的疗效可靠,安全性高。     

Computed tomography and clinical parameters predict intracerebral hemorrhage expansion

This study aimed to evaluate the association of imaging signs, and to establish a predictive model through selecting highly relevant imaging signs in combination with clinical parameters for hematoma expansion.Intracerebral Hemorrhage (ICH) patients who received 2 consecutive noncontrast computed tomography scans were examined and recruited through January 2014 to December 2020. Demographic information and clinical characteristics were collected. Two experienced radiologists reviewed baseline noncontrast computed tomography images to assess the imaging characteristics. Correlation analysis was analyzed with Pearson and Spearman correlation tests. The association between clinical and imaging predictors with hematoma expansion was evaluated in multivariate models. Receiver operating characteristic (ROC) curve analysis was adopted to evaluate predictive performance.A total of 232 ICH patients, with mean age of 59.73 years, and 31% of female were included, among which, 32 patients occurred with hematoma expansion. For sex, ICH density, low density in hematoma, the midline shift, and Glasgow Coma Scale score, liquid level, H-tra, edema Cor, H Volume, time from onset to examination, there were significant differences between the 2 groups. As for imaging signs, only blend sign showed a significant difference, that patients with blend sign had a higher incidence of ICH expansion. The logistic analysis found that radiation attenuation, liquid level, the midline shift, Glasgow Coma Scale score, history of ischemic stroke, and smoking could predict the occurrence of ICH expansion.In summary, the model combined radiological characteristics with clinical indicators showed considerable predictive performance. Further validation is needed to verify the findings and help transfer to clinical practice.     

单侧慢性硬膜下血肿钻孔引流术后复发的临床预测模型建立与验证

目的 研究基于临床资料建立并验证单侧慢性硬膜下血肿(CSDH)钻孔引流术后复发的预测模型.方法 纳入采用钻孔引流治疗的366例单侧CSDH患者.根据首次钻孔后3个月内是否CSDH复发,将患者分为复发组和非复发组;分析比较与CSDH术后复发可能相关的15项因素.采用最小绝对收缩和选择算子(LASSO)回归来降低数据维度和...