自发性小脑出血的外科治疗进展

Progress in Surgical Treatment of Spontaneous Cerebellar Hemorrhage

自发性小脑出血指的是由非外伤性因素,如高血压性动脉粥样硬化、颅内动脉瘤、血管畸形、血液病和中枢神经系统肿瘤等引起的小脑出血。小脑出血起病急,进展快,非常容易侵入第四脑室甚至压迫脑干,从而诱发不可逆损害。小脑出血的诊断主要以影像学诊断为依据,CT和MRI为主要工具,影像学表现在不同部位的小脑出血以及不同时期的小脑出血的表现不同,因此小脑出血的诊断在结合患者病史、体格检查的基础上,联系患者影像学表现从而做出诊断。高血压仍是引起自发性小脑出血的主要病因。自发性小脑出血的治疗主要包括内科保守治疗和外科手术治疗,目前外科手术仍是治疗小脑出血的主要及重要方法,手术治疗能够迅速解除机械压迫,血肿快速清除,有效缓解颅内高压等特点,因而成为小脑出血治疗的重要方法,主要有传统的开颅血肿清除术、侧脑室钻孔引流术、Ommaya囊辅助侧脑室穿刺引流术、立体定向穿刺血肿引流术、神经内镜辅助下血肿清除术、显微外科手术等,疗效和预后目前尚有争议。然而国内小脑出血的诊疗仍存在缺陷,术后仍有部分患者为植物人状态或死亡,建议进一步完善该疾病的健康教育和规范医院诊疗管理,以及小脑出血的早期诊断和治疗,提高预后。

Spontaneous cerebellar hemorrhage refers to cerebellar hemorrhage caused by blood diseases, in-tracranial aneurysms, hypertensive Atherosclerosis, central nervous system tumors and vascular malformations. Cerebellar hemorrhage occurs rapidly and is prone to compressing the brainstem or invading the fourth ventricle, inducing irreversible damage. The diagnosis of cerebellar hemor-rhage is mainly based on imaging diagnosis, with CT and MRI as the main tools. The imaging mani-festations are different in different parts of cerebellar hemorrhage and different periods of cerebel-lar hemorrhage, so the diagnosis of cerebellar hemorrhage is based on the patient’s history and physical examination. Hypertension remains the main cause of spontaneous cerebellar hemorrhage. The treatment of spontaneous cerebellar hemorrhage mainly includes conservative medical treat-ment and surgical treatment. At present, surgery is still the main and important method for the treatment of cerebellar hemorrhage. Surgical treatment can quickly clear the hematoma, relieve intracranial hypertension, and relieve machinery, so it has become an important method for the treatment of cerebellar hemorrhage, mainly including traditional craniotomy hematoma removal, small bone window craniotomy hematoma removal in the posterior cranial fossa, endoscope assist-ed hematoma removal, ultra early microsurgery, stereotactic puncture hematoma drainage CT as-sisted directional soft channel puncture, neuronavigation assisted puncture and drainage, Ommaya capsule assisted Lateral ventricles puncture and drainage, etc. However, there are still some defects in the diagnosis and treatment of cerebellar hemorrhage in China, and some patients are still in vegetative state or death after operation. It is suggested to further improve the health education of the disease and standardize the management of hospital diagnosis and treatment, as well as the early diagnosis and treatment of cerebellar hemorrhage, and improve prognosis.