The Clinical Research With Intraoperative CT Guided Stereotactic Brain Hematoma Removal

ObjectiveHypertensive cerebral hemorrhage (Hypertensive cerebral hemorrhag) is a Cerebrovascular disease, Cerebrovascular diseases, CVD) in a high mortality and morbidity of one of the problems, because of the illness development is rapid, high case fatality rate, the possibility of postoperative complications, looking for effective treatment to reduce mortality and morbidity in patients with critical.The minimally invasive stereotactic surgery is the treatment of hypertensive cerebral hematoma within a very effective method, due to its positioning is very accurate, in the functional areas of the brain in1～2times of puncture, harassment of brain tissue is rather small, tissue reaction is very light;In the removal of hematoma and less damage to surrounding tissue, postoperative brain injury and brain edema reaction, and had no obvious effect on the whole body other organs, fewer complications, therefore is the favour of neurosurgery doctor.Though, is the general lack of stereotactic surgery in May remain hematoma, suction can cause brain damage in the process, even may induce secondary bleeding and puncture bleeding, so some intraoperative use of CT guided stereotactic removal of intracranial hematoma.This study done in intraoperative use of CT guided stereotactic removal of intracranial hematoma, and with ordinary stereotactic removal of intracranial hematoma group control study, opponents of residual hematoma, neurological signs and symptoms, complications, length of hospital stay, behavior ability evaluation index were analyzed, such as explore cerebral hemorrhage (Intra cerebral hemorrhage, for example) patients with the difference of two methods of two methods of operation.MethodsCollection of shanxi coal center hospital neurosurgery2units from November2010to November2012by stereotactic removal of intracranial hematoma in the treatment of hypertensive cerebral hemorrhage patients205cases, in this study,117cases of male, female88cases, aged30-75years, mean age,52.5years;Under the age of40,16cases,113cases of51to60years old,76cases of aged61or over all cases in acute period confirmed by skull CT examination, have a clear history of high blood pressure.In the surgical indications, and eliminate the brainstem function failure, and clotting mechanism obstacles such as contraindications, divided into two groups, separately USES the intraoperative use of CT guide stereotactic and ordinary, rely on head CT guide positioning, data calculation, selection for puncture hematoma largest level targets, use disposable intracranial hematoma puncture needle puncture hematoma size, suction, rinse, and application of enzyme technology, such as injection of urokinase will hematoma liquefaction to scour the hematoma, broken, liquefaction, drainage hematoma removal, and set up evaluation index of treatment effect, according to the data analysis after the conclusion.Results100patients with hypertensive cerebral hemorrhage after under CT guided stereotactic removal of intracranial hematoma, better85cases were cured, and survival of patients with different degrees of sensorimotor disorder such as signs and symptoms, including25cases to achieve full recovery, not leave sequela, social participation ability;40patients with mild-to-moderate limb hemiplegia, but generally life can provide for oneself, no incontinence,6cases of postoperative bleeding again, a second minimally invasive intracranial hematoma removal surgery live;15cases of hemiplegia, obviously need to family care;12cases of different types of aphasia.4days2cases of postoperative pulmonary infection is serious, continuous high fever, antibiotics, automatic discharge, follow-up of death.After30d of curative effect evaluation in patients.CT guided by directional treatment effective rate was95.59%, the ordinary stereotactic group effective rate was90.33%, compared two groups of efficient, chi-square=3.919, P<0.05, the difference was statistically significant.CT guided by directional early surgery in the treatment of the patients died in2cases, the early surgery patients died in3patients, there was no statistically significant difference.CT guided by directional scores14cases pulmonary infection, common stereotactic group of22cases, the more similar between the two groups have statistical significance.6cases CT guided by directional scores bleeding again, ordinary stereotactic group in8cases of bleeding, no statistically significant differences between the two groups (P>0.05).Conclusion1. The clinical effect of intraoperative CT guided stereotactic surgery is superior to the ordinary stereotactic surgery.2. Intraoperative CT guided stereotactic surgery minimally invasive, effective and inexpensive.3. Intraoperative CT guided stereotactic surgery is suitable for the elderly, and some can’t tolerance in patients with general anesthesia.4. Intraoperative CT guided stereotactic surgery can not under the direct operation, with a certain blindness.5. Intraoperative CT guided stereotactic surgery is not suitable for the bleeding, preoperative cerebral hernia to bone disc decompression.