脑干出血的外科治疗现状及进展

Current Status and Progress of Surgical Treatment for Brain Stem Hemorrhage

起病迅猛、进展快、病情重、并发症多的主要特点决定了脑干出血是神经科最为危重、病死率最高、预后最差的疾病,因此,脑干出血一直被作为外科手术的禁忌证,国内外学者大多采取病死率高的保守治疗。但随着现代影像学的不断发展,术中神经导航及电生理监测等新技术的应用和显微外科技术的不断提高,脑干出血的外科手术治疗效果得以明确。该文从脑干的解剖特点及损伤机制、分类分型、手术时机及适应证、外科手术治疗方式及其预后几方面进行全面的综述,以期为脑干出血的外科治疗提供参考建议。

The main characteristics of sudden onset, rapid progress, severe condition and many complications have deter mined that brain stem hemorrhage is the most serious disease, with the highest mortality arid the worst prognosis in neurolog- ical department, therefore, brain stem hemorrhage has been a contraindication to surgery, most scholars at home arid abroad adopt conservation treatment with high mortality. However,with the development of modern imaging,the applications of intr- aoperative nerve navigation and electrophysiological monitoring, and the improvement of microsurgical technology, the effect of brain stem hemorrhage surgical treatment becomes definite. Here is to make a comprehensive review of anatomical charac- teristics and bleeding injury mechanism, classification, timing and indication of operation, mode of surgical treatment and prognosis, in order to provide references for the surgical treatment of brain stem hemorrhage.