小骨窗经侧裂入路显微手术治疗基底节高血压脑出血

目的探讨小骨窗经侧裂入路显微手术治疗基底节区高血压脑出血的手术要点及疗效。方法自2002年3月至2004年9月对32例经CT证实血肿量为30～70mL且未出现脑疝症状的高血压性基底节区出血患者，早期行翼点后小骨窗开颅经外侧裂岛叶入路显微镜下清除血肿术。结果本组病人术后12h内CT复查，血肿清除率80％以上的占84．4％．清除不足70％仅1例：术后再出血1例。出血量不足10mL；随访6个月日常生活能力(ADL）恢复良好率75％，死亡率9．4％，结论在合理选样病例的的提下，小骨窗开开颅经外侧裂岛叶入路显微手术具有创伤少，手术显露满意，清除血肿较彻底，有效降低颅内压，止血牢靠，术后神经功能恢复好，致残、致死率低等优点。

Microsurgery with small bone flap craniotomy and lateral fissure approach in the treatment of hypertensive hemorrhage of basal ganglia region

Objective To explore the effectiveness and operative techniqu e of microsurgery through lateral fissure approach for treating hypertensive hem orrhage of basal ganglia region (HBGH). Methods 32 patients with HBGH from March 2002 to September 2004 accepted at the early stage the microsurgery throu gh small skull window behind pterion and lateral fissure approach to remove the hematoma after they were diagnosed by CT that the hematoma volume is 30~70 mL an d no cerebral hernia occurred. Results The CT re-examination within postop erative 12 h showed that the hematoma was removed by over 80% in 27 cases (84.4% ), below 70% in 1 (3.1%); postoperative rebleeding (< 10 mL) occurred in 1 case; after 6 months follow-up, the ADL was good in 24 cases (75%) and the mortality was 9.4%. Conclusion With proper case selection, microsurgery through late ral fissure approach is a kind of minimally invasive method with little damage, good exposure, comparatively complete hematoma removal, desirable effect of deco mpressing the intracerebral pressure and stopping the blood flow, favorable reco very of neural function and low morbidity and mortality.