超早期小骨窗手术治疗基底节区脑出血

目的探讨小骨窗经侧裂手术治疗基底节区脑出血的手术时机、方法、适应证及治疗效果。方法回顾性分析我院2006年9月至2008年5月采用超早期（发病6h内）小骨窗经侧裂显微手术治疗的116例基底节区脑出血患者的临床资料。结果血肿完全清除109例，血肿清除在80％以上7例；4例出现术后再出血，均为长期服用阿斯匹林患者；无手术死亡病例。3例术后2周内死亡，其中2例为术前已脑疝患者，1例为术后再出血患者。113例好转出院的患者中18例失去联系，95例随访6个月～2年，按日常生活能力评分评定预后，Ⅰ级51例，Ⅱ级26例，Ⅲ级11例，Ⅳ级2例，死亡5例（均死于高血压相关疾病）。结论正确的手术入路、娴熟的显微外科手术方法与技巧对提高基底节区脑出血患者术后生活质量，减少并发症有重要意义。

Ultra-early Microneurosurgery through Pterional Keyhole Approach for Hemorrhage in Basal Ganglia Regions

Objective To investigate the operative opportunity, approach, indication and technique, and curative outcome of ultra-early mieroneurosurgery through pterional keyhole approach for the hemorrhage in the basal ganglia regions. Method The clinical data of 116 patients with basal ganglia hemorrhage treated by ultra-early microneurosurgery through pterional keyhole approach from Septenther, 2006 to May, 2008 were analyzed retrospectively. Results CT examinations within 24 hours after the operation showed that the hematomas were totally removed in 109 patients, and by more than 80% in 7. The rehaemorrhage occurred after the operation in 4 patients, who long took aspirin before the surgery. Three patients died 3 weeks after the surgery. Of 95 patients followed-up from 6 months to 2 years, 51 belonged in grade Ⅰ , 26 in grade Ⅱ, 11 in grade Ⅲ, and 2 in grade Ⅳ according to Activities of Daily Living and 5 died. Conclusions The skillful microneurosurgical technique, and proper operative approach are highly important to the decrease in the postoperative complication and increase in quality of life after the operation in the patients with basal ganglia hemorrhage.