小骨窗开颅手术治疗老年性高血压脑内血肿

目的　探索老年性高血压脑内血肿的微创治疗策略。方法　应用小骨窗开颅技术治疗老年 (>6 5岁 )高血压脑内血肿 2 3例 ,均行血肿直视下清除 ,术后血肿残余大于 15ml者辅以重组链激酶灌注引流。结果　血肿近全清除 12例 ,大部清除 11例。由于老年病人存在脑萎缩 ,血肿清除后减压均较充分。随访 6个月至 2年 ,GOS优 7例 ,中残 12例 ,重残 3例 ,死亡 1例。恢复良好率达 82 6 %。结论　小骨窗开颅手术治疗高血压脑内血肿具有微创、可视、省时等优点。

The enlarged burr-hole craniotomy for treatment of hypertensive intracerebral hematomas in aged patients

Objective To explore the strategy of minimal invasive treatment for hypertensive intracerebral hematomas in aged patients.Methods Twenty-three aged patients(>65 years old) with hypertensive intracerebral hemotoma were treated with the enlarged burr-hole craniotomy.All hematomas were evacuated under direct visualization.If the volume of residual hematoma on follow-up CT was more than 15ml,a drainage procedure was performed after the perfusion of the recombined streptokinase.Results Nearly total evacuation of hematoma was achieved in 12 cases,sub-total evacuation in 11 cases.The decompression was sufficient because of the shrinkage of brain tissues in aged patients.Followed-up for 6 months to 2 years,good recovery was found in 7 cases,moderate disability in 12 cases,severe disability in 3 cases and death in 1 case according to the glasgow outcome scale(GOS).The rate of favorable outcomes was 82.6%.Conclusion The advantages of enlarged burr-hole craniotomy in the treatment of hypertensive cerebral hematomas are minimal invasive,visible and less time-consuming.