Hypertensive Basal Ganglia Hemorrhage Common Procedures For The Treatment Analysis

ObjectiveThis thesis compared three operative methods of the temporal lobe large bone flap operation, minimally invasive hematoma broken ceiling operation and microscope assisted small craniotomy lateral split cranial surgery to discuss surgical treatment of hypertensive basal ganglia hemorrhage.MethodsThe clinical data of patients who received surgical treatment from April,2011 to April,2015 in Anyang Third People’s Hospital contained temporal lobe large bone flap operation 38 cases, minimally invasive hematoma broken ceiling operation 63 cases and microscope assisted small craniotomy lateral split cranial surgery 59 cases. In the three groups, the patients were analyzed uniformly by the general characteristics (sex, age), GCS, bleeding volume, blood pressure, and the preoperative onset time and were followed up for 3 months after the operation. We evaluated efficacy by the analysis of the GOS score and mortality.Results1. General characteristics (sex, age), preoperative GCS score, the preoperative onset time, bleeding volume(by coniglobus formula), admission blood pressure had no significant difference (P>0.05);2. According to the GOS score of 3 months after surgery, there was statistically significant difference (P<0.05) in prognosis efficiency of the temporal lobe large bone flap operation group (hereinafter referred to as the temporal lobe group) and minimally invasive hematoma broken ceiling operation group (hereinafter referred to as the minimally invasive group) and microscope assisted small craniotomy lateral split cranial surgery group (hereinafter referred to as lateral split cranial surgery group). This indicated that the prognosis efficiency of microscope assisted small craniotomy lateral split cranial surgery group and minimally invasive hematoma broken ceiling operation group was better than the temporal lobe large bone flap operation group. But there was no significant difference (P>0.05) in prognosis efficiency of the microscope assisted small craniotomy lateral split cranial surgery group compared with minimally invasive hematoma broken ceiling operation group.3. The total number of patients died in 33 cases (20.6%), there was significant difference (P<0.05) in mortality of both microscope assisted small craniotomy lateral split cranial surgery group and minimally invasive hematoma broken ceiling operation group futher compared with the temporal lobe large bone flap operation group. But there was no significant difference (P> 0.05) in mortality of the microscope assisted small craniotomy lateral split cranial surgery group compared with minimally invasive hematoma broken ceiling operation group. The results showed that both microscope assisted small craniotomy lateral split cranial surgery and minimally invasive hematoma broken ceiling operation were better than the temporal lobe large bone flap operation in terms of mortality. But microscope assisted small craniotomy lateral split cranial surgery had no obvious advantage over minimally invasive hematoma broken ceiling operation.4. The total number of poor prognosis cases was 70 in three groups of patients, in which the bleeding volume> 80ml were a total of 35 cases, accounting for 50.0%, GCS score< 8 points total of 33 cases, accounting for 47.1%. As bleeding volume at 31～50ml, 51-80ml and GCS score 9～12 points,6～8 points, there were significant differences (P<0.05) between the three groups with poor prognosis. As bleeding volume>80ml and GCS score 3-5 points, there were no significant differences (P>0.05) between the three groups with poor prognosis, showing that there was no obvious difference in the choice of surgical procedure as bleeding volume> 80ml and GCS score 3-5 points.Conclusion1. The prognoses of both the microscope assisted small craniotomy lateral split cranial surgery group and the minimally invasive hematoma broken ceiling operation group were better than the temporal lobe large bone flap operation group.2. As bleeding volume< 80ml and GCS score> 8 points, microscope assisted small craniotomy lateral split cranial surgery had advantages for prognosis.3. For patients with massive cerebral hemorrhage, the temporal lobe large bone flap operation could not be replaced.4. With little trauma and simple operation, the minimally invasive hematoma broken ceiling operation could get better prognoses for less bleeding patients.