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目的探讨经中央沟下点-脑岛入路显微手术清除高血压基底核区血肿的改良方法和治疗效果。方法回顾性分析22例采用改良显微手术清除高血压基底核区脑出血病人的临床资料。开颅后于中央沟下点分离外侧裂后支或中央后回下部行1.0~1.5cm皮质切口,经岛叶长回达血肿腔,显微镜下利用锁孔原理清除血肿。结果行小骨窗微创手术10例,去骨瓣减压12例。术后复查头部CT,血肿清除>90%21例,清除70%~80%1例;平均住院天数15d。随访6~12个月,GOS评分:恢复良好10例,中残10例,重残1例,植物生存1例,无死亡病例。结论经中央沟下点-脑岛入路显微手术是治疗基底核区高血压脑出血可行且有效的方法。
Objective To explore the improved method and treatment of hypertensive basal ganglia hematoma by microsurgery of inferior midline - insula approach. Methods The clinical data of 22 patients with hypertensive nucleus of cerebral hemorrhage were retrospectively analyzed with modified microsurgery. After the craniotomy in the central ditch separation of the lateral fissure branch or the central back to the lower line of 1.0 ~ 1.5cm cortical incision through the island leaves back to the hematoma cavity, using the principle of keyhole clearance of the hematoma under the microscope. Results Small bone window minimally invasive surgery in 10 cases, decompressive craniectomy in 12 cases. Postoperative review of head CT, hematoma> 90% 21 cases cleared, 70% to 80% clear one case; the average length of stay 15d. Followed up for 6 to 12 months, GOS score: 10 cases recovered well, 10 cases of moderate disability, 1 case of severe disability, 1 case of plant survival, no deaths. Conclusion Microsurgery via the inferior midline - insula approach is a feasible and effective method for the treatment of hypertensive intracerebral hemorrhage in basal ganglia.