神经内镜辅助手术治疗脑干出血破入第四脑室

Endoscope-assisted microscopic surgery of brainstem hemorrhage with hematoma breaking into the forth ventricle

目的探讨神经内镜辅助显微手术治疗脑干出血破人第四脑室的手术指征、手术方法及效果。方法江苏省无锡市中医医院神经外科自2002年10月至2012年2月采用枕下后正中入路神经内镜辅助显微手术清除脑干出血破入第四脑室患者11例，回顾性分析患者的临床资料和疗效。结果11例患者术后复查头颅CT示脑干血肿清除量为术前血肿总量的87-2％～98．9％（平均94-3％1，随访4个月～2年，恢复良好2例，中残3例，重残2例，植物生存1例，死亡3例。结论神经内镜辅助显微手术治疗脑干出血破入第四脑室具有微创、直视、血肿清除效率高等优点．可以改善患者预后。

Objective To study the surgical indication, surgical method and effectiveness of endoscope-assisted microscopic surgery for brainstem hemorrhage with hematoma breaking into the forth ventricle. Methods Eleven patients having brainstem hemorrhage with hematoma breaking into the forth ventricle, admitted to our hospital fi＇om October 2002 to February 2012 and performed endoscope-assisted microscopic surgery via suboccipital trans-fourth ventricle approach, were chosen in our study; retrospective analysis of their clinical data and outcomes was performed. Results Postoperative CT scan on all 11 patients showed that 87.2%-98.9% （average 94.3%） of the brainstem hematomas in volume were removed. Follow up for 4 months to 2 years showed that neurological outcome improved significantly in 2 patients, moderate disability in 3 patients, severe disability in 2 patients and vegetative state in 1 patient. Three patients died, Conclusion Endoscope-assisted microscopic surgery of brainstem hemorrhage with hematoma breaking into the forth ventricle is minimally invasive and effective with direct-vision; it also improve good neurological outcomes.