The Clinical Study Of Hypertensive Intracerebral Hemorrhage Treated By Minimally Invasive Emergency Operation

Objective: 71 cases with hypertensive intracerebral hemorrhage who were treated in neurosurgery of China-Japan Hospital from January 2006 to January 2008 were analyzed retrospectively.71 cases were divided two groups, 41 in groups A received micro-traumatic hematoma cleaning operation base on medical treatment, 30 in groups B received craniotomy based on medical. Observed the clinical indicators, and evaluated the effectiveness and safety of minimally invasive (MIS) emergency operation for treatment for hypertensive intracerebral hemorrhage, and the timing of surgery on the prognosis.Methods: 71 cases with hypertensive intracerebral hemorrhage who were treated in neurosurgery of China-Japan Hospital from January 2006 to January 2008 were analyzed retrospectively. In the trail 71 cases were divided two groups, 41 in groups A received micro-traumatic hematoma cleaning operation base on medical treatment, 30 in groups B received craniotomy based on medical. The hematoma sit and volume of all patients was identified by CT scan. All the patients'blood pressure was consistent with the diagnostic criteria for hypertension (international standard numerus, BP>140/90mmHg). The age; sex; consciousness of onset; hemorrhage volume and site; blood pressure of the two groups were observed, the operative time on therapeutic was also observed, the effectiveness of the two groups was compared to the effective and safety of minimally invasive emergency operation for treatment for hypertensive intracerebral hemorrhage.Result: There were no significant differences in the age; sex; consciousness of onset; hemorrhage volume and site; blood pressure of the two groups. There was significant delay in waiting timing of craniotomy (95.20±58.54m p<0.05), and also craniotomy had the longest operation time (228.46±49.23m p<0.05). In this trail,22 were received emergency operation within 6h, the effective was 45.4%,45 were received operation within 24h of onset, the effective was 44.4%,4 were received operation after 24h of onset, the effective was 25%,the group received operation within 24h of onset had higher effective rate than the group received operation after 24h of onset, There was no significant difference in GOS score after hospitalization between both groups, and mortality rates between the 2 groups did not show statistically significant differences. The Barthel index score after 3 months of postoperative showed statistically significant differences. There were significant differences in the long-term outcome between the two methods; MIS resulted in better long-term outcome than craniotomy. Conclusions: The waiting time for surgery and the operation time were short, implying that shorter waiting time and shorter operation time is suitable for emergent decompression. The minimally invasive (MIS) evacuation of hematoma can improve the effective rate, decrease the mortality, also it was an effective and safe therapeutic tool for hypertensive intracerebral hemorrhage. The operation for hypertensive intracerebral hemorrhage should be carried out as soon as possible, preferably within the 6 h of onset. If the problem of ultra-early homeostasis was solved, the rate of bleeding after super-early surgery could be reduced.According our experience, our study did conclude that: 1.MIS is suggested for the patients with subcortex and basal ganglia hemorrhage when the hemorrhage volume is 30～50ml, and also suggested for the patients with deep intracerebral hemorrhage such as thalamic hemorrhage when the hemorrhage volume is more than 10 ml. Cerebella hemorrhage often underwent craniotomy.(2)Patients with neurological gradeⅠ～Ⅱ(GCS score,12～15)when the hemorrhage volume is more than 20ml could underwent MIS, because the minimally invasive (MIS) evacuation of hematoma can improve the effective rate.(3) For the aged and (or) with multiple organ dysfunction (MODS) and those can not stand for craniotomy, MIS is most suitable. For those patients MIS is recommended for life saving.Decompressive craniotomy is suggested for the comatose patients with large hematoma when the hemorrhage volume more than 50ml, decompressive craniotomy is recommended when hematoma spread to the thalamus when and patients with cerebral hernia for life saving.