大脑中央核心区高血压性脑出血的分型和内镜手术治疗

Classification and endoscopic surgical treatment of hypertensive cerebral hemorrhage in the cerebral central core

目的探讨大脑中央核心区(cerebral central core,CCC)高血压性脑出血的分型方法及其对选择手术入路的指导意义,并分析内镜手术疗效。方法回顾性分析54例CCC高血压性脑出血病人的临床资料,分为外侧型(n=32)、内侧型(n=18)和混合型(n=4)。外侧型病人采用经外侧裂-岛叶入路内镜手术,内侧型病人采用经Kocher点-侧脑室额角入路内镜手术,混合型病人采用经Kocher点外侧额中回皮质造瘘入路。结果术后24 h复查头部CT显示脑实质血肿完全和近全清除52例(96.3%),大部分清除2例(3.7%);脑脊液循环通路恢复率94.4%。术后2周GCS评分较术前明显提高(P <0.05)。随访12~60个月,无死亡病例,无新发脑积水病人。结论对CCC高血压性脑出血,神经内镜手术是一种微侵袭而有效的方法,术前根据血肿影像学特点进行分型有利于选择合适的手术入路。

Objective To explore the classification method of hypertensive intracerebral hemorrhage in the cerebral central core(CCC)and its guiding significance for selecting surgical approach,and analyze the efficacy of endoscopic surgery.Methods Clinical data of 54 patients with hypertensive cerebral hemorrhage in the CCC were analyzed retrospectively,the patients were divided into lateral type(n=32),medial type(n=18)and mixed type(n=4).Transsylvian-insular approach was performed in the patients with lateral type,lateral ventricle frontal horn approach through Kocher point was used in the patients with medial type,and transcortical approach through the middle frontal gyrus beside Kocher point was performed in the patients with mixed type.Results Total and subtotal evacuations of cerebral parenchymal hematoma were achieved in 52 patients(96.3%)and partial evacuation in 2(3.7%)based on CT scan within 24 hours after the surgery.The recovery rate of cerebrospinal fluidcirculation pathway reached 94.4%.Compared with the preoperation,the GCS scores 2 weeks after the operation were significantly improved(P<0.05).During a follow-up period of 12 to 60 months,no patient died or hydrocephalus occurred.Conclusions Endoscopic surgery is a minimally invasive and effective surgical method for hypertensive cerebral hemorrhage in the CCC,and the preoperative classification according to the imaging characteristics of hematoma is helpful to choose the appropriate surgical approach.