高血压脑出血术中锥体束的保护

Clinical value of DTI for intraoperative protection of pyramidal tract in patients with hypertensive intracerebral hemorrhage

目的探讨高血压脑出血(HICH)术中锥体束保护方法。方法 2010年3月至2013年4月收集49例HICH病人,术前行头颅CT及磁共振弥散张量成像(DTI)检查判断血肿和锥体束的关系,分为锥体束前外侧型血肿和锥体束后内侧型血肿。结果本组31例锥体束前外侧型血肿经侧裂血肿清除术。18例锥体束后内侧型血肿中12行双侧脑室外引流术、6例经纵裂入路血肿清除术。术后6月按日常生活能力分级评估预后,Ⅰ级10例,Ⅱ级22例,Ⅲ级12例,Ⅳ级5例。结论术前CT和DTI检查了解血肿和锥体束关系,对手术具有指导作用。根据锥体束受压移位的情况,采用个体化入路,有助于在最大程度保护锥体束的基础上清除血肿。

Objective To explore the clinical value of diffusion tensor imaging(DTI) for intraoperative protection of pyramidal tract in patients with hypertensive intracerebral hemorrhage(HICH).Methods The clinical data of 49 patients with HICH,who underwent surgery from March 2010 to April 2013,were analyzed retrospectively.The CT and DTI were performed in all patients to confirm the positional relationship between the hemotoma and the pyramidal tract before operation.Results The volume of hemotomas ranged from 30 to 90 ml.The hemotomas located at the anterolateral side of the pyramidal tracts in 31 patients(group A) and at posteriomedial side in 18 patients(group B) according to the CT and DTI before operation.The patients in group A received evacuation of the hemotomas through transsylvian approach.Of 18 patients in group B,12 patients underwent bilateral ventricular drainage and 6 underwent evacuation through interhemispheric approach.The prognosis was assessed by ADL scale 6 months after operation and the outcomes showed that 10,22,12 and 5 belonged to gradeⅠ,Ⅱ,ⅢandⅣ,respectively.Conclusions The DTI has significant instructions to the surgery for patients with HIGH.Individualized surgical approach based on relationship of pyramidal tract and