经外侧裂-岛叶入路神经内镜手术治疗基底节区脑出血

Transsylvian-insular approach endoscopic surgery for basal ganglia hypertensive hemorrhage

目的探讨经外侧裂-岛叶入路神经内镜手术治疗基底节区脑出血的手术技巧及疗效。方法2009年12月至2011年12月对北京世纪坛医院神经外科收治的54例基底节区脑出血患者进行神经内镜手术，均采用小骨窗开颅经外侧裂-岛叶入路内镜手术清除血肿。其中出血量30～40ml者8例，40—50ml者42例，〉50ml者4例，术前格拉斯哥昏迷评分（GCS）评分8～12分48例，13—15分6例。结果54例患者中术后血肿清除达90％以上44例，血肿清除达80％～90％者10例。无2次出血病及无死亡病例。结论经外侧裂一岛叶入路神经内镜手术治疗基底节区脑出血的疗效确切，血肿清除率高，对脑组织损伤小，是一种微创而有效的手术方法，值得临床推广。

Objective To explore the operative techniques and efficacy of transsylvian-insular approach endoscopic surgery for hypertensive basal ganglia hemorrhage. Methods A retrospective analysis was conducted in 54 patients with hypertensive basal ganglia hemorrhage from December 2009 to December 2011. All of them underwent neuroendoscopic surgery via a transsylvian-insular approach. The hematoma volume was 30 - 40 ml （ n = 8）, 40 - 50 ml （ n = 42） and 〉 50 ml （ n = 4 ）. And the Glasgow Coma Scale （GCS） was 8 - 12 （n =48） and 13 - 15 （n =6）. Results The clearance rate of hematoma was 〉90% （ n = 44 ） and 80% - 90% （ n = 10 ）. None suffered re-hemorrhage or death. Conclusion As a mini- invasive and efficacious approach for hypertensive basal ganglia hemorrhage, transsylvian-insular approach endoscopic surgery has a high clearance rate of hematoma is high and causes minimal damage to normal brain tissue. It is worth of clinical promotion.