经侧裂-岛叶入路手术治疗基底核区高血压脑出血

Microsurgical treatment of hypertensive basal ganglia hematomas through transsylvian-transin-sular approach

目的探讨经侧裂-岛叶入路治疗基底核区高血压脑出血的手术方法和临床效果。方法回顾性分析2013年6月至2018年5月山西大医院神经外科连续收治的68例基底核区高血压脑出血患者的临床资料,所有患者均采用经侧裂-岛叶入路清除血肿。术后复查CT评估血肿清除情况。临床预后采用格拉斯哥预后分级(GOS)评估。结果术后24hCT显示,残余血肿量为0~10ml,平均(3.5±0.5)ml,血肿清除率>90%者57例(83.8%),70%~90%者6例(8.8%),<70%者5例(7.4%),手术通道未出现明显的脑水肿和脑挫伤。术后发生再出血1例,肺部感染6例,颅内感染3例,脑积水2例,癫痫1例。死亡3例(4.4%)。存活的65例患者术后6个月时进行GOS分级评估,Ⅳ~Ⅴ级42例,Ⅲ级18例,Ⅱ级5例。结论经侧裂-岛叶入路手术治疗基底核区高血压脑出血安全、有效,选择合适的平面分离侧裂保护静脉,可以建立足够空间的手术通道清除血肿。

Objective To study the surgical experience and clinical efficacy of microsurgical treatment on patients with hypertensive basal ganglia hematomas through transsylvian-transinsular approach. MethodsA retrospective analysis was performed on 68 consecutive patients with hypertensive basal ganglia hematomas who underwent surgical treatment at Department of Neurosurgery,Shanxi Dayi Hospital from June 2013 to May 2018. All of them were operated on for hematomas evacuation through transsylvian-transinsular approach.The degree of hematomas evacuation was evaluated by postoperative CT scan results. Glasgow outcome scale (GOS) was used to access the clinical prognosis. ResultsThe volume of remaining hematoma was 0-10 ml (median: 3.5±0.5 ml) on CT scan obtained 24 hours postoperatively. In this group,near complete (>90%) evacuation was achieved in 83.8%(57/68),70-90% in 8.8%(6/68) and less than 70% in 7.4%(5/68). None of the patients had edema or contusion around the surgical corridor. There were rebleeding in 1 (1.5%) case,severe pulmonary infection in 6,intracranial infection in 3,hydrocephalus in 2 and epilepsy in 1. The mortality rate was 4.4%(3/68). There was 42 cases with good function,18 cases with disability,and 5 cases in vegetative state at 6 months post surgery among 65 surviving patients. ConclusionsMicrosurgery through transsylvian-transinsular approach is one of safe and effective treatments for hypertensive basal ganglia hematomas. Keeping proper dissection plane is crucial to preserve the veins during the sylvian dissection. It could offer a sufficiently wide surgical corridor to evacuate the hematomas.