Clinical Analysis Of Lateral Cleft And Cortex Of Temporal Lobe Approach Therapy In The Treatment Of Intracerebral Hemorrhage

Objective:To compare and analyze the efficacy of lateral cleft and cortex of temporal lobe approach therapy evacuation of hematoma by craniotomy,and to provide reference for clinical treatment of hypertensive cerebral hemorrhage.Methods:A total of 64 patients who underwent evacuation of hematoma by craniotomy because of hypertensive cerebral hemorrhage from September 1,2015 to July 31,2017 at the neurosurgery department of the hospital were randomly assigned to a lateral cleft group(n=33).surgical mode is lateral cleft approach to complete hematoma clearance;cortex of temporal lobe(n=31),surgical mode is cortex of temporal lobe approach to complete hematoma clearance.The preoperative data of two groups of patients,preoperative Glasgow coma scale,preoperative intracranial hemorrhage are compared and analyzed;Postoperative hematoma clearance,the incidence of postoperative complications,brain tissue edema at 72 hours and 7 days after operation,apply China Rehabilitation Research Center Aphasia Examination for patients with dominant hemispheric cerebral hemorrhage to evaluate the language function recovery after 3 months.Use the "BI Index Method" to evaluate patients’Activities of Daily Living(ADL)after 6 months and determine the prognosis.Statistical analysis is performed on SPSS(SPSS,22.0,IBM).Continuity variables are described by mean number ±Π standard deviations(X ± S).Material use the t examination.Classification data are described by frequency(percentage)and χ2 test is used.After controlling irrelevant variables,the statistically significant results of the comparisons among the single factor groups were included in the multivariate analysis after controlling the unrelated variables,and the results were obtained.Results:There is no significant difference in sex,age,preoperative GCS score,bleeding volume,postoperative hematoma clearance and postoperative complications(intracranial infection,pulmonary infection,rebleeding)in the two groups(P>0.05).Compared with the cortex of temporal lobe group,univariate analysis the incidence of postoperative cerebral infarction in the lateral cleft group(0%vs 16.13%,P<0.05),postoperative epilepsy rate(0%vs 12.90%,P<0.05).);at 72 hours after operation,the volume of brain edema(33.91±5.63ml vs 40.42±6.57ml,P<0.001)and the volume of cerebral edema at 7 days after operation(17.36±5.63ml vs 28.03±5.76ml,P<0.001).3 months after operation the Activities of Daily Living score is(125.5±8.74 points vs 93.85±9.76 points,P<0.001).6 months after surgery,the ADL score is(54.24±5.17 vs.46.29±5.47,P<0.001).Compared with the lateral cleft group,multi-factor analysis the incidence of postoperative cerebral infarction in the cortex of temporal lobe group(OR=2.81,P<0.001);at 72 hours after operation,the volume of brain edema(β=-6.52,P<0.001)and the volume of cerebral edema at 7 days after operation(β=-10.78,P<0.001),3 months after operation the Activities of Daily Living score is(β=31.42,P<0.001),6 months after surgery,the ADL score is(β=7.94,P<0.001).Conclusion:The lateral cleft is an effective method for the treatment of hypertensive intracerebral hemorrhage in the basal ganglia,and the lateral cleft approach is better than the cortex of temporal lobe cortico stomy to remove hematoma.