Niizuma H, Ohtsuki T, Ohyama H, Suzuki J
No Shinkei Geka. 1985 Jul;13(7):767-71.
Stereotaxic lateral approach for cerebellar hematoma is presented using Leksell's CT-stereotaxic system. All of the procedures are performed in the CT room. Patient's head is turned to contralateral side of the hematoma 30 to 40 degrees with slight flexion of the neck. Stereotaxic apparatus is secured to the head under local anesthesia. Hematoma is confirmed by computerized tomograms. Three dimensional coordinates of the target point (center of the hematoma) are measured from the vertical and diagonal rods of Leksell's system. Linear skin incision 4 cm in length is made on retromastoid area. Burr-hole is put on just lateral position of the target point, usually 5 to 6 cm posterior and 1 cm above from the external auditory meatus. Transverse or sigmoid sinus does not appeared through the burr-hole by this approach. Specially made Dandy's cannula (3.0 mm in diameter, 220 mm in length) is inserted into the target point, and manual evacuation of the hematoma is performed carefully using a syringe. Then Dandy's cannula is replaced by silastic drainage tube (3.5 mm in diameter), and 6,000 Units of Urokinase solved in 2 ml of saline is administered to the hematoma cavity. Dissolved hematoma is aspirated every 24 hours until the most of the hematoma is evacuated. We operated three cases of cerebellar hematoma by this method with favorable results. Advantages of this method are as follows: Operative invasion is minimal; The surgeon can check the residual hematoma and position of the tip of cannula even at operation, if necessary.
本文介绍了使用Leksell CT立体定向系统对小脑血肿进行立体定向外侧入路的方法。所有操作均在CT室进行。患者头部向血肿对侧转动30至40度，颈部稍屈曲。在局部麻醉下将立体定向装置固定于头部。通过计算机断层扫描确认血肿。从Leksell系统的垂直杆和对角杆测量靶点（血肿中心）的三维坐标。在乳突后区域做一个4厘米长的直线皮肤切口。在靶点外侧位置钻孔，通常在外耳道后方5至6厘米、上方1厘米处。通过这种入路，钻孔处不会出现横窦或乙状窦。将特制的丹迪套管（直径3.0毫米，长度220毫米）插入靶点，用注射器小心地手动清除血肿。然后将丹迪套管换成硅橡胶引流管（直径3.5毫米），向血肿腔内注入溶解在2毫升生理盐水中的6000单位尿激酶。每24小时抽吸一次溶解的血肿，直到大部分血肿被清除。我们用这种方法治疗了3例小脑血肿，效果良好。该方法的优点如下：手术创伤最小；如有必要，术者在手术过程中甚至可以检查残留血肿和套管尖端的位置。
