丘脑出血并发脑室铸型的神经内镜微创手术治疗

Endoscopic removal of thalamus hematoma ruptured into ventricle system

目的丘脑出血并发脑室铸型属于出血性脑卒中疾病中的急危重症,常规手术如脑室外引流或显微手术治疗血肿均存在血肿清除效率低、功能区脑损伤、疗效差等局限。为此探讨应用神经内镜微创手术对此类型出血的治疗方法及疗效。方法苏州大学附属第二医院神经外科自2011年10月至2014年10月采用经脑室神经内镜清除丘脑血肿破入全脑室系统12例,回顾性分析患者的临床资料和疗效。结果术后当日复查CT显示丘脑及脑室内血肿清除率平均为89.2%,术后意识障碍程度明显减轻(P<0.05)。围手术期无再出血、脑室内感染及死亡等并发症发生,疗效优于单纯药物治疗或常规手术者。结论内镜下经脑室清除丘脑及脑室内血肿可避开对丘脑及毗邻功能区的手术创伤,具有微创、高效、对脑功能影响轻微等优势,兼具术式简单、操作简便易行等优点,值得进一步研究应用。

Objective To study the surgical indication,surgical method and effectiveness of endoscopic removal of thalamus hematoma ruptured into the ventricle system. Methods The clinical data and outcomes of 12 patients suffering from thalamus hemorrhage ruptured into the ventricle system,admitted to our hospital from October 2011 to October 2014 and performed minimallyinvasive endoscopic clot removal via trans-ventricle approach,were analyed retrospectively. Results Postoperative CT scan of all 12 patients showed that 82. 7% ~ 94. 1%（ average 89. 2%） hematomas of the thalamus-ventricle system were removed. The follow up from 10 months to 4 years showed that neurological outcome improved significantly in 4 patients,moderate disability in 4,severe disability in 3 and vegetative state in 1. Conclusion Endoscopic removal of thalamus hematoma ruptured into the ventricle system is less invasive and effective,which may help to improve good neurological outcomes.