Department of Neurosurgery, Saiseikai Narashino Hospital, Narashino, Japan.
Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan.
Adv Tech Stand Neurosurg. 2024;52:119-128. doi: 10.1007/978-3-031-61925-0_9.
Cerebral hemorrhage is a frequent disease and one of the main causes of disabilities. Even in the case of cerebral hemorrhage, if there were a treatment that would improve the functional prognosis, the benefits would be immeasurable. Although there are limited reports with a high level of evidence in past studies, it has been found that surgery can be effective if a large amount of hematoma can be removed in a minimally invasive manner. Also, it has become clear that the control of bleeding becomes a problem when surgery is performed within 2 days after the onset of stroke and that the therapeutic time window might be longer. In Japan, since the introduction of the transparent sheath by Nishihara et al., endoscopic hematoma removal has been widely performed and has become the standard surgical procedure. The three basic equipment needed for this surgery are a rigid scope, a suction coagulator, and a transparent sheath. The key point of the surgery is to search for hematomas and bleeding points through a transparent sheath and coagulate the bleeding vessels. In this chapter, we will introduce surgical techniques using these devices, but it is important to carefully decide on surgical options by considering your own technique, the condition of each patient, and the devices available in the area.
脑出血是一种常见疾病，也是导致残疾的主要原因之一。即使在脑出血的情况下，如果有一种治疗方法可以改善功能预后，那么其益处也是不可估量的。尽管过去的研究中证据水平有限的报道很少，但已经发现，如果可以微创地清除大量血肿，手术可能是有效的。此外，当在中风发作后 2 天内进行手术时，手术控制出血会成为一个问题，而且治疗时间窗口可能会更长。在日本，自从 Nishihara 等人引入透明鞘以来，内镜血肿清除术已经得到广泛应用，并且已经成为标准的手术程序。这种手术需要的三种基本设备是硬性内镜、吸引电凝器和透明鞘。手术的关键是通过透明鞘寻找血肿和出血点，并对出血血管进行凝固。在本章中，我们将介绍使用这些设备的手术技术，但重要的是要仔细考虑手术方案，既要考虑到自己的技术，也要考虑到每位患者的情况以及所在地区的设备情况。
