经中央沟下点显微手术治疗基底核区高血压脑出血

Microsurgical treatment of hypertensive cerebral hemorrhage in the basal ganglia through lower point of rolandic fissure approach

目的探讨经中央沟下点-脑岛入路显微手术清除高血压基底核区血肿的改良方法和治疗效果。方法回顾性分析22例采用改良显微手术清除高血压基底核区脑出血病人的临床资料。开颅后于中央沟下点分离外侧裂后支或中央后回下部行1.0~1.5cm皮质切口,经岛叶长回达血肿腔,显微镜下利用锁孔原理清除血肿。结果行小骨窗微创手术10例,去骨瓣减压12例。术后复查头部CT,血肿清除〉90%21例,清除70%~80%1例;平均住院天数15d。随访6~12个月,GOS评分：恢复良好10例,中残10例,重残1例,植物生存1例,无死亡病例。结论经中央沟下点-脑岛入路显微手术是治疗基底核区高血压脑出血可行且有效的方法。

Objective To explore the modified microsurgical techniques and the therapeutic effects of hypertensive cerebral hemorrhage through lower point of rolandic fissure and insular approach.Methods The clinical data of 22 patients with hypertensive cerebral hemorrhage in the basal ganglia removed by the modified microsurgery were analyzed retrospectively.After opening skull,the sylvian fissure branch through lowerpoint of rolandic fissure was separated oran incision of 1.0-1.5 cm in the cortex underthe postcentral gyrus was made.The hematoma cavities were achieved through the long insular gyrus and hematoma was evacuated under the microscope by keyhole.Results The minimally invasive operation by small window craniotomy was performed in 10 patients and decompressive craniectomy in 12.The volume of the remaining hematoma was reexamined by CT scan postoperatively： more than 90%hematoma was evacuated in 21 cases and 70%-80% in 1.The average hospitalization time was 15 days.A follow-up was performed from 12 to 36 months,according to GOS scores： 10 patients recovered well,10 had mild disability,1 severe disability,1 lived in a vegetative state and no one died.Conclusions The microsurgery through lower point of rolandic fissure and insular approach is an available and effective treatment forhypertensive cerebral hemorrhage in the basal ganglia.