Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University, 301 Middle Yanchang Road, Zhabei District, Shanghai 200072, China.
J Clin Neurosci. 2012 Jul;19(7):975-9. doi: 10.1016/j.jocn.2011.09.027. Epub 2012 May 19.
We investigated surgical outcomes of haematoma evacuation in patients with hypertensive putaminal haemorrhage, with emphasis on the development of postoperative refractory intracranial hypertension. Twenty-two consecutive patients with hypertensive putaminal haemorrhage underwent microsurgical clot removal without decompressive craniectomy. Medical histories, radiographic findings, and surgical notes were reviewed. Twenty patients survived to discharge. Twelve patients with preoperative transtentorial herniation, demonstrating a greater haematoma volume and lower Glasgow Coma Scale (GCS) score, had significantly elevated postoperative intracranial pressure. Five of these patients developed refractory intracranial hypertension (42%), and two of these patients died. Conversely, none of the 10 patients without preoperative transtentorial herniation experienced refractory intracranial hypertension, and they had a better outcome at discharge. The preoperative presence of clinical transtentorial herniation may predict the development of postoperative refractory intracranial hypertension, which may require decompressive craniectomy.
我们研究了高血压壳核出血患者血肿清除术的手术结果，重点关注术后难治性颅内高压的发展。22 例连续的高血压壳核出血患者接受了微创手术清除血肿，而未行去骨瓣减压术。回顾了病史、影像学发现和手术记录。20 例患者存活至出院。12 例术前有天幕疝的患者，血肿量更大，格拉斯哥昏迷评分（GCS）更低，术后颅内压明显升高。其中 5 例发生难治性颅内高压（42%），其中 2 例死亡。相反，术前无天幕疝的 10 例患者均未发生难治性颅内高压，出院时预后较好。术前存在临床天幕疝可能预测术后难治性颅内高压的发生，可能需要行去骨瓣减压术。
