早期小骨窗经侧裂显微手术治疗高血压基底节区血肿的疗效观察

目的探讨小骨窗经侧裂入路显微手术治疗基底节区高血压脑出血的技术要点及临床疗效。方法巴中市人民医院神经外科2005年1月至2010年12月对48例经CT证实血肿量为30～50 ml且未出现脑疝症状的高血压性基底节区出血患者,早期行翼点后小骨窗开颅经外侧裂岛叶入路显微镜下血肿清除术。结果术后12小时内CT复查血肿清除率80%以上41例,50%～80%7例;术后再出血2例,出血量≤20 ml。本组死亡4例（8.3%）,存活病例术后6月按照日常生活能力（ADL）评价,自理7例（15.9%）,部分自理20例（45.5%）,中度依赖13例（29.5%）,完全依赖4例（9.1%）。结论小骨窗开颅经外侧裂岛叶入路显微手术具有创伤少、手术显露满意、清除血肿较彻底、有效降低颅内压,术后神经功能恢复良好、致残致死率低等优点。

Clinical observation on efficacy of early small skull window removal of hypertensive intracerebral hematoma via transsylvian approach

Objective To explore the efficacy and operative technique of microsurgery through transsyvian approach for hypertensive basal ganglia hemotoma(HBGH). Methods Fourty-eight patients with HBGH were admited in Department of Neurosurgery,Bazhong Municipal Hospital from Jan 2005 to Dec 2010.The enrolled HBGH patients were diagnosed by CT scan with the hematoma volume of 30～50 ml and without cerebral hernia.The hematomas were removed at the early stage via the microsurgery through small skull window behind the pterion and transsyvian approach. Results The CT re-examination within postoperative 12 hr showed that the hematomas were removed by over 80% in 41 cases(85.4%),between 50% ～ 80% in 7(14.6%).And postoperative rebleeding(< 20 ml) occurred in 2 cases(4.2%).The mortality of this group was 8.3%.In 6 months post-operative follow-up,the activities of daily living of the survival was good in 27/44 cases(61.4%). Conclusions With proper case selection,microsurgery via transsylvian approach is a minimally invasive method which has little damage,good exposure,comparatively complete hematoma removal,desirable effect in decompressing the intracerebral pressure and favorable recovery of neural function,as well as low morbidity and mortality.