Hypertensive intracranial hematomas: endoscopic-assisted keyhole evacuation and application of patent viewing dissector

To study the effect of endoscopic assisted keyhole operation (EAKO) on treating hypertensive intracranial hematomas and the value of our patent dissector appli ed during the operation Methods A total of 25 patients with hypertensive intracranial hematomas underwent endos copic assisted keyhole evacuation, during which, the viewing dissector, which h ad recently achieved national patent, was connected to the tip of endoscope and used to help dissect hematomas The outcome of this procedure were compared wit h those of 22 comparable cases undergone conventional surgical treatment (large or smaller craniotomy) The items for comparison included the volum e of remaining hematoma, the duration of operation, postsurgical Glasgow Coma Sc ale (GCS) and Glasgow Outcome Scale (GOS) Results Remaining hematoma was ascertained 48 h after operation with the use of comp uterized tomography (CT) scans In the case of EAKO, nearly complete evacuation (>84%) was achieved in 21 cases; GCS was evaluated at 7 d postsurgery result ing in GCS >12 in 9 patients, GCS 9-12 in 12 patients and GCS <9 in 4 patients The follow up period ranged from 6 to 21 mon GOS was estimated at half a year and good recovery rate as defined by GOS was assigned to 76% of the EAKO pa tients There are significant differences in the volumes of remaining hematomas and the duration of operation between the EAKO and craniotomy group ( P <0 0 5) In addition, better clinical outcomes were obtained in EAKO Conclusion EAKO has the advantage of being minimally invasive, improving surgical results a nd the prognosis of hypertensive intracranial hematoma patients We conclude th at keyhole operation is a safe, effective alternative for removal of hypertensiv e intracranial hematoma, particularly during acute stages

Individual idea about the micro-invasive aspiration and drainage of intracranial hematoma

AIM： This study aimed to expound the individual idea of micro-invasive surgery from pre-operative preparation, intra-operative processing and post-operative management. METHODS： Pre-operative preparation was improved by analyzing pathological factors and hematoma property, and considering patients＇ age, basic disease, blood pressure control, with persistent haemorrhagia/rehaemorrhagia or not, operative occasion choice, positioning and other procedures. In the surgery, positioner was used. Initial aspiration volume was cautiously controlled. After operation, vital signs of patients were kept stable by cautiously using hematoma liquefacient and combining with free radical scavenger. RESULTS： The core content of individual micro-invasive surgery was mainly to relieve intracranial pressure. Under the condition of sufficient pre-operative preparation known by patients＇ family members, precise positioning was determined and individual therapeutic regimen was made. Meanwhile, caution should be taken in hematoma aspiration. Liquefaction and drainage should be paid more attention, and complications were processed actively. CONCLUSION： During the process of micro-invasive evacuation of intracranial hematoma for treating cerebral hemorrhage, attention should be paid to analyzing cerebral hematoma etiology and pathophysiological mechanism, and individual idea should be considered in surgical treatment aiming at patients＇ concrete disease condition.

Analysis on Emergency Microsurgical Treatment for Cerebral Hernia Caused by Intracranial Anterior Circulation Aneurysm with Intracranial Hematoma

Objective: This study is to discuss CT performances and direct surgical strategy as well as therapeutic effect of patients who have rupture hemorrhage of intracranial anterior circulation aneurysm with complications of intracranial hematoma and cerebral hernia. Methods: CT performances and treatment of 14 patients who have rupture hemorrhage of intracranial anterior circulation aneurysm with complications of intracranial hematoma and cerebral hernia in our hospital from March, 2019 to March, 2021 were reviewed. The relationship between hematoma caused by intracranial anterior circulation aneurysm and position of the aneurysm was analyzed. Besides, surgical processing keys were discussed. Results: For all selected patients, intracranial hemorrhage is proved to be caused by rupture of aneurysm. Among them, there are 2 cases of anterior communicating aneurysms, 3 cases of posterior communicating aneurysms, and 9 cases of middle cerebral aneurysms. According to exploration, we found 1 case of multiple aneurysm, which is the combination of a middle cerebral aneurysm (the responsible aneurysm) and ipsilateral posterior communicating aneurysm. There were two cases of intraoperative rupture. In this study, 3 patients died. According to GOS grading at 3 months after the operation, there were 1 case of V-grade (good recovery), 3 cases of IV-grade (self-maintenance), 5 cases of III-grade (severe disabled), 2 cases of II-grade (persistent vegetative state) and 3 cases of I-grade (died). Conclusions: Emergency microsurgical treatment can lower the death rate of cerebral hernia caused by intracranial anterior circulation aneurysm with intracranial hematoma and recover the neurological functions to the maximum extent.

Research on a bifurcation location algorithm of a drainage tube based on 3D medical images

Based on patient computerized tomography data,we segmented a region containing an intracranial hematoma using the threshold method and reconstructed the 3D hematoma model.To improve the efficiency and accuracy of identifying puncture points,a point-cloud search arithmetic method for modified adaptive weighted particle swarm optimization is proposed and used for optimal external axis extraction.According to the characteristics of the multitube drainage tube and the clinical needs of puncture for intracranial hematoma removal,the proposed algorithm can provide an optimal route for a drainage tube for the hematoma,the precise position of the puncture point,and preoperative planning information,which have considerable instructional significance for clinicians.

Rapid natural resolution of intracranial hematoma

Objective:To investigate the clinical character istics of intracranial hematoma and the mechanism involved in its rapid natural resolution. Methods:Seventeen cases of intracranial hematoma with typical clinical and CT manifestations were retrospectively studied. Results:Intracranial hematoma was found obviously decreased in size within 72 h after its occurrence in 8 cases. The rest 9 cases presented co mplete resolution. Conclusions:Rapid natural resolution of acute epidural hematom a is mostly found in teenagers and the resolution is correlated with cranial fra cture at the hematoma site. As for acute subdural hematoma, its rapid resolution is associated with the transfer of cerebrospinal fluid toward subdural space, t he lavage effect, and the compression caused by the increased intracranial press ure or the space left resulting from redistribution of the hematoma in brain atr ophy.

A PROSPECTIVE STUDY TO EVALUATE THE SAFETY AND EFFICACY USING REMOVING BLOOD STASIS HERBALS FOR PATIENTS WITH INTRACRANIAL HEMORRHAGE OF HYPERACUTE STAGE AND RELATIVE FACTORS OF HEMATOMA ENLARGEMENT(A MULTICENTER PROSPECTIVE RANDOMIZED DOUBLE-BLIND PLACEBO

The aim was to investigate whether using a removing blood stasis method in hyperacute intracranial hemorrhage stage can lead to hematoma enlargement and its clinical efficacy.A multicenter retrospective randomized double-blind placebo-controlled clinical study.We recruited patients aged 18 years or older and presenting at less than 6 h from symptom onset in 8 research centers.All the patients

飞行员头部外伤后坐过山车致颅内硬膜下血肿一例

一、临床资料 患者,男性,35岁,运-8飞行员,飞行时间1000 h.2011年1月2日乘坐单位大巴车外出,因急刹车右侧颞顶部碰撞到前座后背,当时无头痛、头晕,无意识障碍,局部无红肿、头皮撕裂,未就诊.2月6日陪孩子坐过山车,头部无碰撞伤.2月7日排便时感头痛、头昏,站立不稳,自行休息后减轻,但头痛、头昏持续存在,且逐渐加重.2月14日到体系医院就诊,头颅CT示:右侧额颞顶部亚急性硬膜下血肿.查体:四肢自主活动,肌力左右侧、上下肢均正常.血尿便常规、空腹血糖、血脂均正常.ECG示:窦性心动过缓,心率49次/min.入院后脱水治疗,行硬膜下血肿钻孔引流术.

The Effect of integrated Traditional Chineseand Western Medicine on the Recovery of Patients with Early Acute Cerebral Hemorrhage

The author compared in this study the effects of the treatment with integrated traditional andwestern medicine with that of routine western medicine alone on the recovery of patients with acute hyperten-sive cerebral hemorrhage. The results of the treatments showed that integrated traditional Chinese and west-ern medicine had better effect on speeding up the absorption of intracranial hematoma, elimination of en-cephaledema and restoration of neural functions than routine western medicine. There is significant differencebetween the results of the two kinds of treatment (P< 0. 05￣0. 01 ) , which suggested that treating patientsearly with traditional Chinese medicine greatly helps the recovery of patients with cerebral hemorrhage.