应用神经内窥镜外鞘经额上入路治疗基底核区出血的效果

Treatment of hypertensive intracerebral hemorrhage through supra-frontal approach by using a neuroendoscopic sheath

目的探讨应用神经内窥镜外鞘经额上入路手术治疗高血压性基底核区出血的效果。方法对18例高血压性基底核区出血患者于发病24h内选择额上入路，使用内窥镜外鞘作为操作通道，以神经内窥镜及常规吸引器通过内窥镜外鞘进行血肿清除。结果手术时间平均为55min。术中发现大脑中动脉中央支活动性出血13例。术后1d复查头部CT，出血量按多田氏公式计算。血肿全部清除2例，血肿大部清除（〉90％）11例，部分清除（〈90％）5例。随访时间3～11个月，平均7个月。除1例术后死于冠心病外，ADL评分：Ⅰ级7例，Ⅱ级4例，Ⅲ级3例，Ⅳ级2例，Ⅴ级1例。结论神经内窥镜结合内窥镜外鞘，使术野有一定的操作空间，避免术中内窥镜物镜的模糊，改善内窥镜的视野。为微创手术治疗高血压性脑出血提供了有益的探索。

Objective To investigate the effectiveness of surgical treatment of hypertensive cerebral hemorrhage in basal ganglia through supra-frontal approach by using a neuroendoscopic sheath. Methods Supra-frontal approach was selected in 18 patients with hypertensive basal ganglia hemorrhage within 24 hours after the onset of symptoms. Using an endoscopic sheath as an operation thoroughfare, hematoma evacuation was conducted with neuroendoscope and conventional aspirator through the endoscopic sheath. Results The mean operative time was 55 minutes. The active bleeding from central branches of the middle cerebral artery was found in 13 patients during the operation. CT examination of the brain was repeated 1 day after the operation, and the bleeding volume was calculated by Tada＇s formula. The hematoma was completely evacuated in 2 patients ; subtotally evacuated （ 〉 90% ） in 11 patients, and partially evacuated （ 〈 90% ） in 5 patients. The patients were followed-up for 3 to 11 months （ mean, 7 months ）. Apart from one patient died of coronary heart disease, the ADL score was grade Ⅰ in 7 patients, grade Ⅱ in 4 patients, grade Ⅲ in 3 patients, grade Ⅳ in 2 patients, and grade Ⅴ in 1 patient. Conclusions Neuroendoseope in combination with endoscopic sheath provide a surgical field for evacuation of intraeerebral hematomas the blur of endoscopic objective lens during the operation and improved the visual field of the endoscope. It is in accordance with the principle of minimally invasive surgery for management of hypertensive intracerebral hemorrhage.