经冠状缝-额中回入路神经内镜手术治疗高血压性基底节区出血的标准化流程分析

Standardized procedure of neuroendoscopic surgery via coronal suture-middle frontal gyrus approach for patients with hypertensive basal ganglia haemorrhage

目的总结一种简单实施、有效的、标准的经冠状缝-额中回入路神经内镜手术治疗高血压性基底节区出血的标准化流程。方法回顾性分析2019年4月至2021年4月按统一标准实施的经冠状缝-额中回入路神经内镜手术治疗的48例高血压性基底节区出血的临床资料。术中未使用神经导航及3D-slicer等软件辅助定位。结果术后24 h内复查头CT显示残余血肿量中位数为2.4(1.1~3.9)ml;血肿清除率中位数为94.0%(90.0%~98.0%)。无术后再出血。出院时GCS评分中位数为13(11~14)分。术后随访6~30个月(中位数15个月),mRS评分0~2分35例,3~4分10例,5~6分3例。结论神经内镜下经冠状缝-额中回入路手术治疗高血压性基底节区出血是一种简单易行的手术方式,无需神经导航及3D-slicer等软件辅助定位,可以取得良好的手术效果。

Objective To summarize a simple-to-use, standardized and effective procedure of neuroendoscopic surgery via middle coronal suture-frontal gyrus approach for the patients with hypertensive basal ganglia haemorrhage(HBGH). Methods The clinical data of 48 patients with HBGH who received neuroendoscopic surgery via coronal suture-middle frontal gyrus approach from April 2019 to April 2021 were analyzed retrospectively. Software-assisted positioning such as neuronavigation and 3D-slicer was not used during the operation. Results CT within 24 hours after operation showed that the median volume of residual hematoma was 2.4(1.1~3.9) ml, and the median rate of hematoma clearance was 94.0%(90.0%~98.0%). There was no postoperative rebleeding. The median GCS score at discharge was 13(11~14). Postoperative follow-up(range, 6~30 months;median, 15 months) showed that mRS score of 0~2 was achieved in 35 patients, score of 3~4 in 10, and score of 5~6 in 3. Conclusions Neuroendoscopic surgery via coronal suturemiddle frontal gyrus approach for the patients with HBGH is a simple and easy operation. It does not require software-assisted positioning such as neuronavigation and 3D-slicer, and can achieve a good outcome.