经侧裂岛叶入路显微手术清除高血压基底节区血肿

Sylvian insular approach for microsurgical removal of hypertensive basal ganglia hematoma

目的探讨超早期经外侧裂-岛叶入路显微手术治疗高血压性基底节血肿的临床疗效。方法对68例高血压性基底节血肿的患者采取翼点入路切口经外侧裂-岛叶入路清除血肿。结果本组68例患者术后10h48例意识状况转为神志清楚,10例好转,6例无改善。3周内死亡4例,死亡率5.9%。随访3~6个月,神经功能按ADL分级进行测评：I级~Ⅱ级25例（36.8%）：Ⅲ级22例（32.4%）;Ⅳ级6例（8.9%）;V级（植物生存）3例（4.4%）,失访8例（11.8%）。结论经外侧裂-岛叶入路手术是治疗高血压基底节区脑出血较理想的方法,具有对脑组织损伤小、易发现出血点、神经功能恢复好等优点。

Objective To evaluate the clinical efficacy of early stage fissure,insular approach for microsurgical treatment of hypertensive basal ganglia hematoma.Methods Totally 68 patients with hypertensive basal ganglia hematoma in patients taking pterional incision lateral fissure-insular approach to remove the hematoma.Results Totally 68 patients in this group after 10h 48 cases into conscious awareness of the situation,10 cases improved,6 cases no improvement.4 deaths in 3 weeks,the mortality rate 5.9%.Followed up 3 to 6 months,neurological evaluation conducted by ADL classification： I ~ Ⅱ grade level in 25 cases（36.8%）： Ⅲ grade 22 cases（32.4%）;Ⅳ 6 cases（8.9%）;V level（plants survival） in 3 cases（4.4%） lost 8 cases（11.8%）.Conclusions The lateral fissure-insular approach for basal ganglia surgery is the treatment of hypertensive cerebral hemorrhage ideal method and has less brain tissue damage,easy to find the bleeding point,and good recovery of nerve function.