神经内镜经纵裂胼胝体入路治疗重型脑室出血

Endoscopic treatment through interhemispheric transcorpus callosal approach for severe intraventricular hemorrhage

目的探讨神经内镜下经纵裂胼胝体入路治疗重型脑室出血的临床应用价值及疗效。方法 26例重型脑室出血患者,采用自制透明内镜导管,制备人工脑脊液,内镜下经纵裂胼胝体入路清除脑室出血,对其疗效及预后进行分析。结果 26例患者术后第一天头颅CT检查平均血肿清除率92.7%。术后第一周原发性脑室出血中GCS评分13.6分,与术前相比有统计学意义(P<0.01);继发性脑室出血中GCS评分12.8分,与术前相比有统计学意义(P<0.01)。26例中1例死亡,2例出现再出血,1例发生颅内感染。术后3个月随访,GOS分级:Ⅴ级14例、Ⅳ级4例、Ⅲ级4例、Ⅱ级3例。结论神经内镜下经纵裂胼胝体人路治疗重型脑室出血明显改善病人预后,并发症低,是治疗重型脑室出血的较佳手术方法。

Objective To evaluate the value and effect of endoscopic surgery for severe intraventrieular hemorrhage through interhemispheric transeorpus callosal approach. Methods The clinical data of 26 patients with severe intraventricular hemorrhage were operated and evacuated hematoma by neuroendoscopic surgery through interhemispheric transcorpus callosal approach were analyzed retrospectively. Results After 24 hours, nearly complete evacuation of intraventricular hernatoma was in all patients. The GCS one week after the operation was significantly higher than that before the operation （ P 〈 0. 01 ）. There was intracranial infection in 1 patient, 1 died and secondary hemorrhage in 2 after surgery. All patients were followed up for three months. According to G OS, of 25 patients,14 were recovered well,4 moderately disabled,4 severely disabled and 3 vegetatively survived. Conclusions Neuroendoscopic surgery through interhemis-pheric transcorpus callosal approach for severe intraventricular hemorrhage may be a better surgical treatment with low complication and excellent outcomes.