To Study Clinical Effects Of Stereotaxic Punction And Aspiration Of Hematoma For Hypertensive Intracerebral Hemorrhage

Background: Hypertensive intracerebral hemorrhage (HICH) accounts for approximately 70 % of spontaneous intracerebral hemorrhage. Though the level of its clinical diagnosis and treatments is gradually rising abroad and at home, its mortality and mutilation rate are still higher than other cerebrovascular diseases. Traditional surgical operation for HICH is craniotomy and evacuation of hematoma, but its outcomes havenot favourable.Objective: To study postoperative clinical effects of stereotaxic punction and aspiration of hematoma treating HICH in contrast to craniotomy and evacuation of hematoma in order to search for a more effective operative method.Methods: From June 2004 to June 2007, 80 Cases of HICH with 30ml～90ml hematoma volume at department of neurosurgery of the forth attached hospital in Guangxi Medical University and were mean divided into 2 groups according to operative method: stereotaxis group and traditional craniotomy group. CT guided stereotaxic punction and aspiration of hematoma on the basis of local anesthesia were carried out in stereotaxis group. skull excision or little skull window and evacuation of hematoma were fulfiled under the condition of systemic anesthesia in traditional craniotomy group. Some potential preoperative influence factors such as age, sex, bleeding part, hematoma volume, GCS at hospitalization were treated by statistics to eliminate difference and reinforce comparability between groups. Cases of cure, improvement, no progression, death and cases of complications such as pulmonary infection, alimentary tract hemorrhage, recurrent bleeding and ventriculomegaly in postoperative 30 days were record in each group and carried out control study.Results: In postoperative 30 days, 36 cases(90%) of 40 ones in stereotaxis group survive and 23 cases (57.5%) were cured;7 cases(17. 5%) pulmonary infection and 5 cases(12. 5%) alimentary tract hemorrhage and 2 cases (5%) recurrent bleeding within postoperative 30 days. 29 cases(72. 5%) of 40 ones in traditional craniotomy group survive and 12 cases(30%) were cured;15 cases(37. 5%) of 40 ones pulmonary infection and 13 cases (32.5%) alimentary tract hemorrhage and 8 cases (20%) recurrent bleeding . To analyze cure rate, death rate and incidence of complications of each factor:stereotaxis group shows statistic significance (P<0. 05) in contrast to traditional craniotomy group. With regard to those of cerebroventricular hematoma in postoperative 30 days, 10 cases (47.6%) of 21 ones in stereotaxis group were cured ,3 cases(14.3%) died; 3 cases (14.3%)with ventriculomegaly;3 cases(16.7%) of 18 ones in traditional craniotomy group were cured ,6 cases (33. 3%) died, 8 cases (44. 4%) with ventriculomegaly. Analysis on death rate between two groups manifests no significance (P>0.05);but analysis on postoperative cure rate and ventriculomegaly rate between them stereotaxis group shows significance(P<0. 05) in contrast to traditional craniotomy group. Conclusion: Stereotaxic punction and aspiration of hematoma for HICH manifests operational procedure is simpler and has the advantage of minimally invasion, wider indicatio of operation, fewer postoperative complications, higher survival rate and higher cure rate than traditional craniotomy and evacuation of hematoma. It is a more effective operative method with clinical value to be spread to HICH.