■观察常规去骨瓣减压血肿清除术和基于框架的立体定向微创手术(MIS)治疗幕上颅内血肿疝的疗效。
■本研究对49例高血压脑出血并发小脑幕疝患者进行了回顾和分析。入院后6h内通过急诊手术清除颅内血肿。根据授权代表的意愿和同意,149例患者中的74例采用常规去骨瓣减压术,然后清除血肿,定义为CDC组,其余75例患者接受了基于框架的立体定向MIS进行ICH后送,定义为MIS组。手术入院之间的间隔,手术的持续时间,医源性出血量,术后再出血的发生,比较两组患者神经功能恢复情况。所有患者均随访3个月。继发性癫痫,在植物人状态下生存,严重的肺部并发症,死亡率,并记录和比较日常生活活动(ADL)分类。
■入院和手术之间的间隔,手术的持续时间,与CDC组相比,MIS组的术中出血量明显减少。死亡率,再出血率,植物状态的患病率,与CDC组相比,MIS组的严重肺部并发症明显减少。在MIS组中,幸存者(ADL)等级也显示出优势。
■在高血压ICH并发小脑幕疝的手术治疗中,与常规开放手术相比,基于框架的立体定向ICHMIS显示出优势.
UNASSIGNED: To observe the therapeutic effect of conventional decompressive craniectomy with hematoma evacuation and frame-based stereotactic minimally invasive surgery (MIS) for supratentorial intracranial hematoma with herniation.
UNASSIGNED: One hundred forty-nine patients with hypertensive ICH complicated with tentorial herniation were reviewed and analyzed in the present study. The intracranial hematoma was evacuated by emergency surgery within 6 h after admission. According to the authorized representatives\' wishes and consent, 74 of the 149 patients were treated by conventional decompressive craniectomy followed by hematoma removal, defined as the CDC group, and the remaining 75 patients underwent frame-based stereotactic MIS for ICH evacuation, defined as the MIS group. The intervals between the admission to surgery, the duration of surgery, the amount of iatrogenic bleeding, the occurrence of postoperative rebleeding, and the recovery of neurological functions were compared between the two groups. All patients were followed up for 3 months. Secondary epilepsy, survival in a vegetative state, severe pulmonary complications, mortality, and activities of daily living (ADL) classification were also recorded and compared.
UNASSIGNED: The interval between admission and surgery, the duration of surgery, and intraoperative blood loss in the MIS group were significantly decreased compared to the CDC group. The mortality rate, the rate of rebleeding, prevalence of vegetative state, and severe pulmonary complications in the MIS group were remarkably decreased compared to the CDC group. In the MIS group, the survivors\' (ADL) grade also showed advantages.
UNASSIGNED: In the surgical treatment of hypertensive ICH complicated with tentorial herniation, frame-based stereotactic MIS for ICH showed advantages compared to conventional open surgery.