立体定向引导下前额锁孔入路神经内镜血肿清除术治疗中等量高血压基底核区脑出血的效果

目的:探讨立体定向引导下前额锁孔入路神经内镜血肿清除术治疗中等量高血压基底核区脑出血患者的效果。方法:选取2018年3月至2019年7月郑州中康医院神经外科收治的95例中等量高血压基底核区脑出血患者，男56例，女39例，年龄(60.26±3.59)岁，年龄范围为50～75岁。按照手术方式的不同分为开颅手术组( ...

Effect of stereotactic guidance of forehead keyhole approach neuroendoscopic hematoma removal in the treatment of moderately hypertensive patients with basal ganglia cerebral hemorrhage

Objective To investigate the effect of stereotactic guided forehead keyhole approach neuroendoscopic hematoma removal in the treatment of moderately hypertensive patients with basal ganglia cerebral hemorrhage.Methods From March 2018 to July 2019,95 patients with moderately hypertensive basal ganglia cerebral hemorrhage admitted to the department of Neurosurgery of Zhengzhou Zhongkang Hospital were selected.There were 56 males and 39 females,aged(60.26±3.59)years old,ranging from 50 to 75 years old.According to the surgical method,patients were divided into the combined treatment group(n=47)and the neuroendoscopy group(n=48).In the open surgery group,small bone flap craniotomy for hematoma removal combined with bone flap reduction was performed,while in the neuroendoscopy group,stereotactic guided forehead keyhole approach for neuroendoscopic hematoma removal was performed.The postoperative hematoma clearance rate,surgical effect,nerve function and complications were compared between the two groups.Results The clearance rate of hematoma in the neuroendoscopy group[(96.23±1.99)%]was higher than that of the combined treatment groups[(65.23±10.23)%],and the difference was statistically significant(P<0.05).The difference comparison of operation time between the two groups was not statistically significant(P>0.05).The pupil recovery time of the neuroendoscopy group was[(48.32±7.98)hours]which was shorter than that of the combined treatment group[(53.26±8.01)hours],and the difference was statistically significant(P<0.05),2 weeks after surgery,the Glasgow coma scale score of the neuroendoscopy group was[(9.85±0.92)points]which was higher than the combined treatment group[(8.12±0.89)points],and the difference was statistically significant(P<0.05);in the National Institutes of Health Stroke Scale(NIHSS)scores of the two groups before surgery patients had no statistically significant difference(P>0.05).The NIHSS scores after 1 month,3 months and 6 months of patients in the neuroendoscopy group[(22.41±3.15)points,(14.32±2.65)points,(12.03±1.95)points]were lower than those of the combined treatment group[(25.36±4.10)points,(18.32±3.37)points,(15.52±2.52)points],and the difference was statistically significant(P<0.05);There was no statistically significant difference in complications between the two groups(P>0.05).Conclusion Stereotactically guided forehead keyhole approach neuroendoscopic hematoma removal can reduce the damage to the nerves and better remove the hematoma by changing the incision approach and applying neuroendoscopy to better remove the hematoma,thereby improving the treatment effect and shortening the recovery time of the pupil.It will not prolong the operation time and increase complications,and it is worthy of clinical application.