颅后窝血肿39例治疗体会

Treatment experience of 39 cases posterior cranial fossa hematoma

目的 :评价 3 9例颅后窝血肿的治疗方法及效果。方法 :3 9例颅后窝血肿分别采用保守治疗 ,枕部开瓣术 ,微创术治疗。结果 :保守治疗 15例 ,死亡 1例 ;枕后开瓣治疗 10例 ,死亡 2例 ;微创治疗 14例 ,无 1例死亡。结论 :对于颅后窝血肿量大于 15ml或四脑室完全阻塞 ,横窦骑跨性血肿 ,均采用枕部开瓣术 ,治疗效果好 ;对于生命体征平稳 ,血肿量在 10～ 15ml之间 ,四脑室未完全阻塞者 ,采用微创术治疗效果良好 ;对于生命体征不平稳 ,血肿量大或脑损伤重者 ,采用咬除枕骨 ,清除血肿及坏死组织 ,因病情重 ,疗效差。

Objective: To value the treatment method and outcome of 39 cases posterior cranial fossa hematoma.Methods: 39 cases posterior cranial fossa hematoma were separately treated by the conservative treatment.The occiput craniectomy and the minimally invasive surgical intervention.Results: Conservative treatments in 15 cases,died in 1 cases;occiput craniectomy treatments in 10 cases,died in 2 cases;the minimally invasive surgical intervention in 14 cases,all are successfull without death.Conclusion: To use occiput craniectomy which posterior cranial fossa hematoma was over 10 ml,the fourth ventrical was all blocked and which the hematoma strode over transverse sinus,clinical outcome was good.To use the minimally invasive surgical intervention which life system sign kept calm.Hematoma measure were between 10～15 ml and the fourth ventricle was not all blocked,clinical outcome was very good.To use that occipital was bitten off at the same time hematoma and necrotissue were eliminated,which life system sign could not keep calm and hematoma measure were bigger or brain injury were severity,clinical outcome was poor because state of an illness were severity.