高血压脑出血致小脑幕切迹疝的手术治疗

Surgical treatment of transtentorial hernia complicated with hypertensive cerebral hemorrhage

目的探讨高血压脑出血并发小脑幕切迹疝手术治疗的适应证及疗效。方法手术治疗33例，根据CT定位，对幕上血肿行开颅去骨瓣减压术，主要以脑室出血者单纯行脑室穿刺引流术。从生存质量评估分析中，寻找手术适应证、手术注意事项及围手术期处理方法。结果本治疗组所有病例均存活，按格拉斯哥昏迷预后评分（GOS）：良好22例，中残7例，重残4例，无植物生存和死亡病例。结论提高手术治疗高血压脑出血并发小脑幕切迹疝成功率的关键在于严格掌握适应证，尽早清除血肿，充分减压，并加强围手术期的处理。

Objective To explore the therapeutic efficacy of surgical treatments of patients with transtentorial hernia caused by hypertensive cerebral hemorrhage. Methods Thirty-three patients received operative therapy. Intracerebral hematoma was removed with skull flap or skull window craniotomy. Results All patients survived . The therapeutic effects were evaluated by GOS which showed good recovery or mild disablement in 22 cases, moderate disablement in 7 cases, severe disablement in 4 cases. Conclusion The successful rate of surgical treatment of transtentorial hernia complicated with hypertensive cerebral hemorrhage is related to strictive selection of patients and elimination of haematoma at early stage.