自发性小脑血肿手术治疗的体会

Surgery for Spontaneous Cerebellar Hemorrhage:A clinical analysis of 13 Cases

目的总结自发性小脑血肿治疗的体会。方法回顾性分析1999年10月—2008年12月收治的13例自发性小脑血肿患者的病例资料,结合文献报道进行分析总结。结果10例患者行后颅减压、血肿清除术,其中9例在血肿清除前先行脑室外引流术;3例患者行单纯脑室外引流术。10例施行血肿清除的患者小脑血肿最大径都在4.0cm以上。13例患者术后随访3个月～2年,格拉斯哥预后量表(GOS)评分4～5分8例,GOS评分3分1例,自动出院1例,死亡3例。3例术前出现急性呼吸循环衰竭的患者中1例恢复良好。结论自发性小脑血肿手术治疗疗效肯定,血肿最大径≥4.0cm的患者多需要手术治疗;患者并发呼吸循环衰竭并不是手术治疗的禁忌证。

Objective To summarize the experience in surgical therapy for spontaneous cerebellar hemorrhage. Methods The data of thirteen patients with spontaneous cerebellar hemorrhage, hospitalized and treated surgically in our department from October 1999 to December 2008, were retrospectively analyzed and summarized in combination of reviewing the literature reports. Results Ten patients underwent hematoma evacuation by suboccipital craniectomy, nine of them with preceding extra-ventricular drainage; three patients underwent ventricular drainage only. The maximum diameter of hematoma of the ten patients with hematoma evacuation was all more than 40mm. All the 133 patients were followed for 3 months to 2 years. There were eight patients whose Glasgow Out-come Scale （GOS） was 4 or 5, one patient whose GOS was 3; one patient who left the hospital voluntarily, and three patients who died. One of the three patients with cardiopulmonary failure had a good recovery. Conclusion Surgical treatment is of effect for cerebellar hemorrhage. It is necessary for the patients with a cerebellar hematoma of 40mm or more, and a patient with cardiopulmonary failure is not contraindicative for surgery.