额颞部大骨瓣开颅侧裂入路治疗合并脑疝的高血压脑基底节出血临床分析

目的探讨应用额颞部大骨瓣开颅经外侧裂入路显微手术治疗高血压脑基底节出血并脑疝病人的治疗效果。方法回顾性分析26例重症高血压脑基底节出血并脑疝病人的临床资料。这些病人均采用额颞部大骨瓣开颅。骨窗以翼点为中心，大小约8cm×10cm^3，向下至颧弓上缘，向后至顶结节前2cm。显微镜下经外侧裂入路进入血肿腔、清除血肿。10例术中还纳骨瓣，16例行硬脑膜减张缝合后去除骨瓣。术后患者入神经外科重症病房治疗。结果患者平均住院20．6d，其中住重症病房5．9d。出院时，幸存20例，死亡6例。幸存的20例患者，随访3～12个月，按日常生活活动分级，Ⅱ级9例，Ⅲ级5例，Ⅳ级2例，Ⅴ级2例，死亡2例。结论额颞部大骨瓣开颅侧裂入路是治疗重症高血压脑基底节出血的良好方法，熟练的显微外科操作、规范的术后治疗可以提高疗效。

Large Fronto-temporal Craniotomy and Microneurosurgery through Transsylvian Approach for Hypertensive Hemorrhage in Basal Ganglia Region Complicated by Cerebral Hernia

Objective To explore the therapeutic effect of large fronto-temporal craniotorny and mieroneurosurgery through transsylvian approach on severe hypertensive hemorrhage in basal ganglia region complicated cerebral hernia. Methods The clinical data of 26 patients with severe hypertensive hemorrhage in basal ganglia regions complicated by with cerebral hernia were analyzed retrospectively. The large fronto-tempory craniotomy was periormed in all the patients. The center of cranial bone window which covered an area of 8 c m×10 cm, was the plerion. The hematomas were removed by mieroneurosurgery through transsylvian approach in all the patients. The cranial bones were reduced in 10 patients and not in 16 patients during the operation. Results The average stay was 20.6 days in 26 patients, of whom, 20 survived and 6 died the after operation. Of 20 survivors who were followed up from 3 to 12 months, 9 belonged in grade Ⅱ , 5 in grade Ⅲ, 2 in grade Ⅳ, 2 in grade Ⅴ and 2 died according to activities of daily living. Conclusions Large fronto-temporal eraniotomy and microneurosurgery through transsylvian approach for the hematomas is a good method to treat severe hypertensive cerebral hemorrhage in the basal ganglia region. The skilful microsurgieal skill and normative postoperation therapeutics may improve the prognoses in the patients with severe hypertensive cerebral hematoma in the basal ganglia regions complicated cerebral hernia.