基底节区高血压脑出血CT分型及手术策略

目的 探讨高血压基底节区脑出血的CT影像学分型、手术术式选择和治疗效果.方法 56例高血压基底节区脑出血患者,依据CT影像中出血部位和累及区域将基底节区出血分为四个类型及三个亚型:(1)前部型;(2)中间型;(3)后部型:①后内侧型,②后中间型,③后外侧型;(4)混合型.对不同分型患者分别选择经侧裂-脑岛入路或经中央沟下点-脑岛入路,总结技术要点,对术后效果进行评价.结果 56例患者前部型占7%(4例);中间型占20%(11例);后部型占41%(23例):后内侧型占9%(5例),后中间型占21%(12例),后外侧型占11%(6例);混合型占32%(18例).采用经侧裂-脑岛入路清除血肿的占41%(23例),经中央沟下点-脑岛入路的占59%(33例).术后复查头颅CT,52例血肿清除＞90%,3例血肿清除＞75%,1例血肿清除＞50%,平均住院天数15.8 d.根据GOS评分:恢复良好13例,中残29例,重残12例,植物生存2例,无死亡病例.结论 该分类法对于手术入路的选择具有指导意义,经侧裂-脑岛入路和经中央沟下点-脑岛入路清除基底节区血肿效果可靠、再出血概率少,具有微创、神经功能恢复好等优点.

Abstract：

Objective To analyze the surgical strategy of hypertensive striatocapsular hemorrhage according to a new classification method designed on the basis of CT scans.Methods The clinical and neuroimaging data of 56 consecutive patients with hypertensive striatocapsular hematoma who underwent surgical management were collected in the neurosurgical department of Renji hospital from January 2008 to January 2010.The hematomas were divided into four types and three subtypes: (1) the anterior type; (2)the middle type; (3) the posterior type and its three Transsylvian - transinsular approach or translower - rolandic - point (LRP) - transinsular approach was chosen respectively to treat these patients according to our new classification method.Results In this group, 4 patients (7%) were anterior type,11 (20 % ) middle type, 23 (41% ) posterior type, and 18 (32%)mixed type.In posterior type, 5(9%) patients were posteromedial type, 12 (21%) posteromiddle type, and 6 (11%) posterolateral type.Transsylvian -transinsular approach was taken in 23 patients (41% ), and transLRP -transinsular approaches in 33patients (59 %).The volume of the remaining hematoma was measured by postoperative CT scans: nearly 90%evacuation was achieved in 52 cases, 75% in 3, and 50% in 1 case.According to GOS score, 13 cases returned to preoperative life status, 29 cases recovered sufficiently to return to family life, 12 cases could ambulate with a crutch but needed assistance, 2 cases lived with a vegetative state, and none was dead.Conclusions The new classification will be helpful for surgical strategy of managing hypertensive striatocapsular hemorrhage.Transsylvian -transinsular and transLRP- transinsular approaches should be advocated.

A new classification method of hypertensive striatocapsular hemorrhage based on CT scans and mini - invasive surgical strategy

Objective To analyze the surgical strategy of hypertensive striatocapsular hemorrhage according to a new classification method designed on the basis of CT scans.Methods The clinical and neuroimaging data of 56 consecutive patients with hypertensive striatocapsular hematoma who underwent surgical management were collected in the neurosurgical department of Renji hospital from January 2008 to January 2010.The hematomas were divided into four types and three subtypes: (1) the anterior type; (2)the middle type; (3) the posterior type and its three Transsylvian - transinsular approach or translower - rolandic - point (LRP) - transinsular approach was chosen respectively to treat these patients according to our new classification method.Results In this group, 4 patients (7%) were anterior type,11 (20 % ) middle type, 23 (41% ) posterior type, and 18 (32%)mixed type.In posterior type, 5(9%) patients were posteromedial type, 12 (21%) posteromiddle type, and 6 (11%) posterolateral type.Transsylvian -transinsular approach was taken in 23 patients (41% ), and transLRP -transinsular approaches in 33patients (59 %).The volume of the remaining hematoma was measured by postoperative CT scans: nearly 90%evacuation was achieved in 52 cases, 75% in 3, and 50% in 1 case.According to GOS score, 13 cases returned to preoperative life status, 29 cases recovered sufficiently to return to family life, 12 cases could ambulate with a crutch but needed assistance, 2 cases lived with a vegetative state, and none was dead.Conclusions The new classification will be helpful for surgical strategy of managing hypertensive striatocapsular hemorrhage.Transsylvian -transinsular and transLRP- transinsular approaches should be advocated.