MRI引导下立体定向基底节区血肿纵向抽吸引流术

MRI-guided stereotactic longitudinal Aspiration and drainage of hematomas of basal ganglia region

目的:介绍磁共振成像(magneticre sonance imaging,MRI)引导下的立体定向基底节区血肿纵向抽吸引流术的优越性和体会。方法:30例高血压性基底节区血肿患者头部安装Leksell立体定向框架,经MRI扫描定位制定手术计划。经枕外侧入路,应用Backblund抽吸器沿血肿纵向抽吸血肿,外引流经尿激酶(Urokinase,UK)溶解的残余血凝块。结果:本组病例中,术中仅抽吸血肿量的70%～80%,血肿消失的平均时间为3.5天,2例术后3～4天分别死于急性心肌梗死和肺栓塞,其余患者临床症状均得到改善。结论:MRI能显示出受血肿挤压、移位的外侧裂血管,提供了更为全面清晰的三维结构影像信息。经枕外侧入路MRI引导的立体定向血肿纵向抽吸引流术,有利于血肿的清除和避免损伤外侧裂血管,最大限度减少了手术损伤和病人的痛苦,缩短了住院时间。

Objective To report the superiority and experience of magnetic resonance imaging (MRI)-guided stereotactic longitudinal aspiration and drainage of hematomas of basal ganglia region. Methods The Leksell stereotactic frame (Elekta Instrument) was used in 30 cases with hypertensive hematomas of basal ganglia region and which were examined and localized with MRI for the operative planning. The hematomas were eliminated by Backblund evacuator aspiration then the residual coagulated blood was dissolved with Urokinase(UK) and drained out through the tube via the lateral occipital approach. Results In 30 cases 70%～80% volume of hematoms was evacuated and the mean time of elimination of hematomas was 3.5 d. 2 cases died from acute cardiac infarction and pulmonary embolism 3～4 d after the operation respectively and the clinic status of other patients showed improvement. Conclusion MRI revealed the flow void images on the frontal and lateral side of the hemotomas which were compressed and shifted Sylvian blood vessels. On the other hand MRI provided clear overall data of the form volume and adjacent anatomic structures of the hemotomas for the stereotactic neurosurgeons. Via the lateral occipital approach MRI-guided stereotactic longitudinal aspiration and drainage of the hematomas contributed to eliminating the hematomas and avoiding damage of the Sylvian blood vessels,and such minimally invasive techniques would have the advantage of minimizing surgical exposure and patient discomfort as well as shortening hospital stay.