经外侧裂岛叶入路显微清除高血压性基底节区脑出血

Transsylvian-transinsular approach for the microsurgical removal of hypertensive basal ganglia hemorrhage

目的探讨在显微镜下经外侧裂-岛叶入路清除高血压性基底节区脑出血的手术要点及脑组织和血管保护。方法回顾性分析18例经外侧裂-岛叶入路显微手术清除基底节区高血压脑出血患者临床资料。术后复查头颅CT了解血肿清除情况。采用Karnofsky功能状态评分评估术后3-6个月患者功能状态。结果本组血肿清除〉90%16例,80%-90%1例;再出血1例。其中1例患者因术后严重肺部感染死亡。随访3-6个月,KPS 90-100分3例,60-80分9例,30-50分4例,10-20分1例。结论经外侧裂-岛叶入路有利于保护重要的大脑皮层和血管,是显微清除高血压性基底节区脑出血安全有效的手术方式。

Objective To explore the key points of transsylvian-transinsular approach to remove the hypertensive basal ganglia hemorrhage and adjacent brain tissue and blood vessels protection.Methods The clinical data of 18 patients who underwent the transsylvian-transinsular approach to remove the hypertensive basal ganglia hemorrhage were analyzed retrospectively. The volume of remaining hematoma was evaluated by postoperative CT scan. The Karnofsky performance score was used to evaluated patient outcome of 3- 6 months after the surgery. Results The evacuation rate of hematoma was 〉90% in 16 patients and 80%-90% in 1. One case occured rehemorrhage. One patient died from severe pulmonary infection. The follow-up from 3 to 6 months showed KPS was 90- 100 in 3 patients,60 - 80 in 9,30 - 50 in 4 and 10 - 20 in 1. Conclusion The transsylviantransinsular approach was benefit to protect important cerebral cortex and vessels,thus being a safe and effective operation method for microscopic removal of hypertensive basal ganglia hemorrhage.