早期经翼点外侧裂-岛叶入路显微手术治疗高血压基底节区脑出血的临床研究

Early microsurgery through Pterional lateral fissure-Insula approach in the treatment of hypertensive hemorrhage of basal ganglia region

目的探讨早期经翼点外侧裂-岛叶入路显微手术治疗高血压基底节区脑出血的手术要点及疗效。方法回顾分析2003年1月～2009年12月26例经CT证实血肿量为30ml以上的高血压基底节区出血患者,早期行翼点外侧裂-岛叶入路显微镜下清除脑出血血肿手术的临床资料。结果本组患者术后第1d行头颅CT复查,血肿清除量均在90%以上。住院期间死亡3例,病死率11.5%。生存的23例患者随访6个月日常生活能力(ADL)Ⅰ级0例,Ⅱ级6例,Ⅲ级(需人帮助,扶拐可行)9例(45.67%),Ⅳ级6例,Ⅴ级(植物生存)2例。结论早期经翼点外侧裂-岛叶入路显微手术治疗高血压基底节区出血创伤小、手术显露满意、清除血肿较彻底、能有效降低颅内压,是基底节区高血压脑出血的有效手术治疗方式。

Objective To explore the surgical method and therapeutic effect of early microneurosurgery via pterional transsylvian fissure-insular approach in the treatment of hypertensive hemorrhage of basal ganglia region.MethodsFrom January 2003 to December 2009,26 patients with hypertensive hemorrhage of basal ganglia region（HBGB） underwent early microsurgery via pterional lateral fissure-insula approach for the hematoma above 30ml proved by CT scan.ResultsThe extent of hematoma evacuation was above 90%.Mortality was 11.5%（3/26）.After 6 months follow up,the patients were evaluated by activities of daily living（ADL）,GradeⅠ was found in 0 case,Ⅱ in 6 cases,Ⅲ in 9 cases,Ⅳ in 6 cases,Ⅴ in 2 cases.ConclusionEarly microneurosurgical treatment via transsylvian fissure-insular approach for cerebral hematoma in basal ganglia region is a kind of minimally invasive method with less damage,better effects and more favorable prognosis.