自发性小脑出血手术治疗策略

目的探讨自发性小脑出血的外科治疗。方法回顾性分析采用手术治疗的30例自发性小脑出血患者的临床资料。对蚓部出血6~10mL、出现梗阻性脑积水的患者行单纯侧脑室钻孔引流术,对小脑半球出血10~20mL者行后颅窝开颅血肿清除术,对小脑半球出血量20mL或蚓部出血量10mL者行后颅窝开颅血肿清除+寰枕减压术+侧脑室钻孔引流术。结果单纯侧脑室钻孔引流术6例,恢复良好5例;中残1例;后颅窝开颅血肿清除术14例,恢复良好10例,中残2例,重残2例;后颅窝开颅血肿清除+寰枕减压术+侧脑室钻孔引流术10例,恢复良好6例,中残2例,重残1例,死亡1例。结论对自发性小脑出血患者,积极手术治疗,根据出血的部位、出血的量、有无合并梗阻性脑积水等情况,采用不同的手术方式。

Surgical strategies in the treatment of spontaneous cerebellar hemorrhage

Objective To investigate the surgical treatment in spontaneous cerebellar hemorrhage.Methods The clinical data of 30 patients with spontaneous cerebellar hemorrhage treated by surgical strategies were retrospectively analyzed.Lateral ventricle drilling drainage was done for the obstructive hydrocephalus patients with cerebellum vermis hemorrhage of 6-10 mL.Posterior fossa craniotomy was performed for the patients with cerebellar hemisphere hemorrhage of 10-20 mL.Posterior fossa craniotomy and atlanoccipital decompression and lateral ventricle drilling drainage were done for the patients with cerebellar hemorrhage of more than 20 mL or vermis hemorrhage of more than 10 mL.Results Lateral ventricular drainage was performed in 6 cases,among whom 5 cases showed good recovery and 1 case presented moderate disability.Posterior fossa craniotomy was done in 14 patients,among whom 10 cases had good recovery,2 cases showed moderate disability and 2 cases showed severe disability.Posterior fossa craniotomy and atlanoccipital decompression and lateral ventricle drilling drainage were carried out in 10 patients,among whom 6 cases showed good recovery,2 cases showed moderate disability and 1 case showed severe disability and 1 case diad.Conclusion Patient with spontaneous cerebellar hemorrhage should be actively treated by surgical strategies which should be carefully done according to bleeding location,bleeding amount and whether complicated with obstructive hydrocephalus.