显微血管减压术后颅内出血的原因及应对策略

目的探讨显微血管减压(MVD)术后颅内出血的原因及应对策略。方法对12例面肌痉挛、三叉神经痛MVD术后颅内出血患者的临床资料进行回顾性分析,并对相关文献进行复习。结果本组患者中,小脑半球实质内血肿者3例,小脑出血破入脑室3例,蛛网膜下腔出血2例,脑室出血2例,后颅窝硬膜外血肿1例,幕上硬膜下血肿1例。1例脑室出血铸型患者家属放弃治疗,出血后48 h内死亡;4例患者行开颅血肿清除+后颅窝减压术;1例小脑半球实质内血肿患者采用立体定向穿刺引流术;2例患者单纯行侧脑室穿刺引流术;1例慢性幕上硬膜下血肿患者行钻孔引流术;3例患者采用保守药物及腰穿治疗。预后:康复5例,重度残疾1例,复合颅神经损害3例,死亡3例(住院期间死亡2例,出院半年内死亡1例)。结论MVD术后颅内出血具有较高的病死率、致残率,为MVD术后最严重的并发症之一。围手术期血压控制不良、责任血管发出穿支血管包绕神经出脑干区(REZ)及小脑半球牵拉干扰程度重是导致MVD术后颅内出血发生的原因。术后进行床旁移动CT检查能及时发现早期颅内出血,可有效降低其病死率和致残率。

Intracranial hemorrhage following microvascular decompression and the solutions

Objective To explore the etiology and coping strategies for intracranial hemorrhage after microvascular decompression(MVD).Methods The clinical data of 12 patients with intracranial hemorrhage after MVD for hemifacial spasm and trigeminal neuralgia were analyzed retrospectively,and the relevant literatures were reviewed.Results In this group of patients,there were 3 intracerebral hematoma,3 cerebellar hemorrhage extended into ventricle,2 subarachnoid hemorrhage,2 intraventricular hemorrhage,1 posterior fossa epidural hematoma and 1 supratentorial subdural hematoma.One patient with intraventricular hemorrhage was abandoned treatment and died within 48 hours after hemorrhage.Four patients were treated with craniotomy,evacuation of intracranial hematoma and posterior fossa decompression.One case of intracerebral hematoma was treated with stereotactic puncture and drainage.Two cases were treated with lateral ventricle puncture and drainage.One case of chronic supratentorial subdural hematoma underwent drilling and drainage.3 cases were treated with conservative medicine and lumbar puncture.The prognosis showed 5 cases were cured.1 was severely disabled,3 were complicated with cranial nerve damage and 3 died(2 died during hospitalization,1 died within half a year after discharge).Conclusions Intracranial hemorrhage following MVD has a high mortality and disability rate,and it is one of the most serious complications after MVD.Poor blood pressure control during the perioperative period,the perforating blood vessels from the responsible blood vessels that surround the nerve root exit zone(REZ)and severe cerebellar hemisphere traction are the independent risk factors for intracranial hemorrhage after MVD.Bedside mobile CT for head CT examination can find early intracranial hemorrhage in time,which can effectively reduce the mortality and disability rate after bleeding and improve the prognosis.