超早期小骨窗外侧裂入路显微手术治疗高血压性基底节脑出血

Microsurgical treatment via small bone flap craniotomy through lateral fissure approach for hypertensive basal ganglia hemorrhage during ultra-early period

目的总结超早期小骨窗外侧裂入路显微手术治疗高血压性基底节脑出血经验。方法2001年3月～2005年2月，我科对33例高血压性基底节脑出血6h内超早期手术，采用小骨窗开颅，经外侧裂、岛叶入路，显微镜下清除血肿，去骨瓣减压，不放引流，术后严格控制高血压。结果术后CT复查血肿清除彻底。术后肺炎2例。按格拉斯哥预后评分标准随访3个月，良好23例，中残10例。结论超早期小骨窗外侧裂入路显微手术治疗高血压性基底节脑出血，具有创伤小，清除血肿彻底，并发症和致残率低，恢复功能快等优点。

Objective To summarize the clinical experience of microsurgical treatment via small bone flap craniotomy through lateral fissure approach for hypertensive basal ganglia hemorrhage during ultra-early period. Methods A total of 33 patients with hypertensive basal ganglia hemorrhage were given microsurgical treatment within 6 hours after stroke. The operation was performed under small bone flap craniotomy through lateral fissure and insular lobe approach. The hematoma was cleaned under microscope for decompression, and no drainage was used. The high blood pressure was strictly controlled after operation. Clinical records were analyzed retrospectively. Results Postoperative CT examination showed the hematoma cleaning rate over 95%. Complicated pneumonia occurred in 2 patients. Follow-up assessment according to the Glasgow Outcome Scale （GOS） for 3 months revealed good recovery in 23 patients and moderate disability in 10 patients. Conclusions Mierosurgieal treatment via small bone flap eraniotomy through lateral fissure approach for hypertensive basal ganglia hemorrhage during ultra-early period has advantages of little invasion, thorough removal of lesion, low incidence of complications and disability, and fast functional recovery.