显微血管减压术后颅内出血的原因分析及预防

Analysis of causes and solutions of intracranial hemorrhage following microvascular

目的探讨显微血管减压术治疗颅神经疾病术后颅内出血的发生原因及处理方法。方法回顾我科自2000年10月-2012年12月颅神经疾病（面肌痉挛、三叉神经痛等）接受显微血管减压手术患者2105例中术后颅内出血者共10例。根据疾病特点、病例特征、术中术后病情变化等探讨颅内出血的发生原因及机制，研究其预防及处理方法。结果颅内出血总体发生率0．48％，10例术后颅内出血患者死亡2例，完全康复8例。死亡原因均为术区再出血，其中1例术后经反复手术、抢救后半年内植物状态，最终仍死亡。其中术区出血5例，硬膜外血肿2例，蛛网膜下腔出血3例。结论颅神经疾病显微血管减压手术后颅内出血发生率较低，后果严重，部分患者常表现为术后迟发出血，为临床所忽视，术前患者的选择、术中精细操作、术后规范管理及病情监测可避免此严重并发症的发生。

Objective To study the causes and treatments of intracranial hemorrhage following microvascular decompression operation（MVD）. Methods We reviewed 10 cases in 2105 who suffered from cranial nerve diseases （including Hero_i--facial spasm and trigeminal neuralgia） from October 2001 to December 2012 in our department. We discussed the possible causes of intracranial hemorrhage by ana- lyzing the characteristics of these cases. We also discussed the proper treatments for this serious complica- tio民. Results The rate of postoperation intracranial hemorrhage of MVD is 0. 48 %. Two cases died and eight of the ten recovered at last. One patient remained vegetative state for half a year in our department and finally died. Of all the cases, five developed hemorrhage in operation area and two developed subdural hepatoma,others developed subarachnoid hemorrhage. Conclusion Ntracranial hemorrhage following mi- crovascular decompression is a rare complication, it is extremely terrible because of its high death rate. It maybe ignored because it usually occurs more than 24hours, sometimes even several days after the opera- tion. Meticulous operations and postoperative monitoring are necessary for avoiding the severe complica- tion.