Craniotomy With Small Bone Hole For Hypertensive Intracerebral Hemorrhage And The Factors Affecting The Early Prognosis After Operation

Objective To evaluate the effectiveness and safety of craniotomy with small bone hole for hypertensive intracerebral hemorrhage (HICH), and to explore the factors affecting the early prognosis after operation.Methods Clinical data of 51 patients diagnosed as HICH after surgical treatment with craniotomy with small bone hole were retrospectively analyzed. The statistical methods include t-test, chi-square test, Fisher exact test of probabilities, Wilcoxon signed rank test, and analysis of variance.Result The mortality rate of patients in this series was 23.5%. The survivals with vegetative state and severe handicap account for 39.2%. According to consciousness grade, the mortality rate of patients was 0 in I -III, 9.76% in IV, 80% in V respectively. The statistical significant predictors of early prognosis include systolic pressure on admission, consciousness grade on admission, pupil changes, cerebral hernia, GCS-M, volume and location of hemorrhage, midline structure shift, peri-diencephalon cisterns , acute obstructive hydrocephalus and postoperative rebleeding etc. However, the age, sex, history of hypertensive disease, diastolic pressure on admission, rupture of hematoma into ventricles and the operative occasion (≤ 7h or > 7h) have no significant influence on prognosis.Conclusion Craniotomy with small bone hole is effective and safe, and it can be thought as a kind of minimally invasive procedure for HICH based onpreoperative exact localization of hematoma. The operative treatment suits for the patients with grade I -IV, and the optimal operating time was within 24 hours after onset.The early prognosis of patients with HICH is associated with many factors. The blood pressure on admission, consciousness grade on admission, pupil changes, cerebral hernia, GCS-M, volume and site of hemorrhage, midline structure shift, peri diencephalon cisterns, acute obstructive hydrocephalus and rebleeding after operation can be used as the important indexes for the early prognosis of patients with HICH treated with craniotomy with small bone hole.