个体化入路手术治疗高血压基底节区出血

目的探讨个体化入路手术治疗高血压基底节区出血操作技巧及其疗效。方法 2009年12月至2011年6月收治高血压基底节区脑出血患者58例,根据临床表现及CT检查等,采取个体化入路手术。16例侧裂前型血肿经额上沟、额中回或额下沟入路手术清除,23例侧裂中心型血肿经侧裂-岛叶入路手术清除,19例侧裂后型血肿经颞中回或中央沟下点-脑岛入路手术清除。结果术后复查CT显示血肿清除达到90%以上24例,70%~90%22例,而少于70%6例;术后再出血3例,死亡3例。55例术后随访6个月,根据日常生活活动能力(ADL)评价预后,45例预后好(ADL 1~3级),10例预后差(ADL 4~5级)。结论采用个体化入路手术清除基底节区脑出血及术后合理的治疗可以明显降低患者死亡率,改善其预后。

Treatment of hypertensive basal ganglia hemorrhage by neurosurgery through individualized approach (report of 58 cases)

Objective To improve the surgical treatment of the hypertensive basal ganglia hemorrhage and curative effect on it.Methods Neurosurgery through the individualized approach was performed in 58 patients with hypertensive basal ganglia hemorrhage from December,2009 to June,2011.The hematomas in the anterior lateral prefissure were evacuated by the neurosurgery through the superior frontal sulcus or midfronral gyrus or inferior frontal sulcus approach in 16 patients.The hematomas in the lateral fissure centers were evacuated by the neurosurgery through the lateral fissure-insular lobe approach in 23 patients.The hematomas in the posterior lateral fissure were evacuated by the neurosurgery through the midtemporal gyrus or lower part of the central sulcus-insular approach in 19 patients.Results Postoperative CT scanning showed that more than 90% volume hematomas were evacuated in 24 patients,70%~ 90% in 22 and less than 70% in 6.The rebleeding occurred in 3 patients and 3 patients died after the operation.The following up 6 months after the operation showed that 45 patients were recovered well(gradeⅠto Ⅲ) according the activities of daily life(ADL).Conclusion The neurosurgery through the individualized approach and postoperative appropriate treatment may decrease the mortality and improve prognosis in the patient with hypertensive basal ganglia hemorrhage.