Shi Jing, Zou Xiaohua, Jiang Ke, Tan Li, Wang Likun, Ren Siying, Mao Yuanhong, Yang Chunguang, Wang Weijun, Wu Guofeng, Tang Zhouping
The Affiliated Hospital of Guizhou Medical University, Postal Address: No. 28, Guiyijie Road, Guiyang City, Postal Code 550004, People's Republic of China.
Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Postal Address: No. 28, Guiyijie Road, Guiyang City, Postal Code 550004, People's Republic of China.
Transl Neurosci. 2021 May 15;12(1):198-209. doi: 10.1515/tnsci-2020-0173. eCollection 2021 Jan 1.
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.
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.
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.
In the surgical treatment of hypertensive ICH complicated with tentorial herniation, frame-based stereotactic MIS for ICH showed advantages compared to conventional open surgery.
观察传统去骨瓣减压血肿清除术与基于框架的立体定向微创手术（MIS）治疗幕上颅内血肿合并脑疝的疗效。
回顾性分析149例高血压脑出血合并小脑幕切迹疝患者。所有患者入院后6小时内行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例接受传统去骨瓣减压血肿清除术，定义为CDC组；其余75例患者接受基于框架的立体定向MIS清除脑出血，定义为MIS组。比较两组患者入院至手术的间隔时间、手术时间、医源性出血量、术后再出血的发生率以及神经功能的恢复情况。所有患者均随访3个月。记录并比较继发性癫痫、植物生存状态、严重肺部并发症、死亡率以及日常生活活动（ADL）分级情况。
与CDC组相比，MIS组入院至手术的间隔时间、手术时间及术中出血量均显著减少。与CDC组相比，MIS组的死亡率、再出血率、植物状态发生率及严重肺部并发症均显著降低。在MIS组中，幸存者的ADL分级也显示出优势。
在高血压脑出血合并小脑幕切迹疝的外科治疗中，与传统开放手术相比，基于框架的立体定向MIS治疗脑出血显示出优势。
