暴发型第四脑室扩张性血肿的显微手术探讨

The surgical strategy of microsurgical treatment for fulminant hemorrhagic dilation of the fourth ventricle

目的探讨暴发型第四脑室扩张性血肿改良手术方法的有效性及其优势。方法回顾性分析山西省人民医院2009年10月至2014年12月诊治的21例经急诊手术治疗的暴发型第四脑室扩张性血肿的临床资料。所有病例均先行侧脑室穿刺外引流术，随后采用枕下后正中经小脑蚓部入路清除血肿并行改良寰枕减压术，术后通过调控侧脑室外引流管流速精准控制颅内压。结果术后死于脑干功能衰竭1例，20例存活患者术后随访6～17个月，Karnofsky功能状态评分（KPS评分）90分以上者8例，60～90分者6例，30～60分者4例，不足30分者2例。随访期间无脑积水复发及后颅窝积液病例。结论脑室外引流术的新理念结合改良的显微手术术式不仅能够有效提高暴发型第四脑室扩张性血肿的救治成功率，而且极大地降低了传统术式的术后并发症的发生率。

Objective To investigate the effectiveness and advantage of improved microsurgery for fulminant hemorrhagic dilation of the fourth ventricle. Methods The clinical data of 21 patients with fulminant hemorrhagic dilation of the fourth ventricle were analyzed retrospectively. All patients underwent hemorrhage evacuation and improved atlantooccipital decompression via middle suboccipital trans-cerebellar vermis approach, with preceding external ventricular drain. Results One patient died of brainstem failure postoperative, and 20 patients were followed up from 6 to 17 months. There were 8 patients whose KPS exceeded 90, 6 patients whose KPS were 60 to 90, 4 patients whose KPS were 30 to 60, and two patients whose KPS were lower than 30. There was no recurrence of hydrocephalus and posterior fossa fluid. Conclusions The improved microsurgery for fulminant hemorrhagic dilation of the fourth ventricle not only could effectively raise the success rate of salvage, but also greatly reduce postoperative complications compared with traditional mode.