改良大骨瓣减压、显微侧裂入路治疗伴脑疝的高血压基底节区脑出血

Modified large decompressive craniectomy and microneurosurgery through transsylvian treating hypertensive basal ganglia hemorrhage complicated cerebral herniation

目的评价改良大骨瓣减压、经外侧裂入路显微手术治疗伴脑疝的高血压基底节区脑出血患者的治疗效果。方法回顾性分析30例高血压基底节区脑出血并脑疝患者的临床资料,均采用改良大骨瓣减压术,显微镜下经外侧裂入路清除血肿,术后按照高血压性脑出血临床救治指南进行治疗。结果随访6个月,按日常生活能力分级(ADL),ADLⅠ级3例,ADLⅡ级14例,ADLⅢ级9例,ADLⅣ级2例,ADLⅤ级1例,死亡1例。结论改良大骨瓣减压术治疗高血压基底节区脑出血伴脑疝疗效满意,娴熟的显微外科操作、规范的综合治疗可改善患者预后。

Objective To evaluate the efficacy of modified large decompressive craniectomy and microneurosurgery through transsylvian on hypertensive basal ganglia hemorrhage complicated with cerebral herniation.Methods The clinical data of 30 patients with hypertensive basal ganglia hemorrhage complicated cerebral herniation were analyzed retrospectively.The modified large decompressive craniectomy was performed in all the patients.The hematomas were removed by microneurosurgery through transsylvian approach in all the patients. Postoperative treatment in accordance with the Guide to clinical treatment of hyperten-sive cerebral hemorrhage. Results With 6 months follow-up after the operation ,the clinical curative effect was evaluated by activities of daily living（ADL）.The effect showed that 3 patients were ADLⅠ ,14 patients were ADL Ⅱ ,9 patients were ADLⅢ ,2 patients were ADL Ⅳ ,1 patient was ADL Ⅴ ,1 patient died. Conclusion The modified large decompressive craniectomy may have good efficacy on hypertensive basal ganglia hemorrhage complicated cerebral herniation ;and the skilful microsurgical skill and normative with comprehensive therapeutics will improve the prognosis.