Surgical Treatment For Supratentorial Hypertension Intracerebral Hemorrhage Via Small Bone Window Craniotomy Assisted By Neuroendoscopy

Purpose To study and compare the clinical effect of small bone window craniotomy combined with neuroendoscope versus traditional large hemicraniectomy in the treatment of supratentorial hypertension intracerebral hemorrhage,and provide evidence for clinical surgical treatment.Methods Retrospective analysis of patients with supratentorial hypertension intracerebral hemorrhage who treated surgery in the Department of Neurosurgery,affiliated Hospital of Yangzhou University,affiliated Hospital of Xuzhou Medical University,Subei People's Hospital from February 2014 to June 2018.The patients were divided into observation group(small bone window craniotomy with neuroendoscopy group)and Control group(traditional large hemicraniectomy group).Analysis and comparison of general data of the two groups,including gender,age,hemorrhage volume,hematoma location,GCS score at admission,arterial systolic pressure at admission,previous hypertension and diabetes,preoperative preparation time,length of surgery,hematoma clearance,postoperative pulmonary infection,gastroenteritis,intracranial infection,gastrointestinal bleeding,postoperative rebleeding and epilepsy,and modified Rankin Scale(mRS)at 6 months postoperatively.All the data were processed using SPSS 19.0 software and were statistically significant at<0.05.Results A total of 64 patients were included in the study,including 30 in the observation group and 34 in the control group.The result suggests:(1)There were no significant differences in gender,age,hemorrhage volume,hematoma location,GCS score at admission,arterial systolic pressure at admission,previous hypertension or diabetes,and preoperative preparation time(P>0.05);(2)Compared with the control group,the length of surgery of the observation group was significantly decreased(2.14±0.56 h vs 2.72±0.66 h,P<0.05);the clearance rate of intracranial hematoma in the observation group was<80%and>80%,the respective cases were20.10,the clearance rate of intracranial hematoma in the control group was<80%and 10%in>80%.the respective cases were24,10,there was no significant difference in the clearance rate of intracranial hematoma between the two groups(P>0.05);(3)The incidence of pulmonary infection and epilepsy of the observation group was lower than that of the control group(P<0.05).And There were no significant difference in the incidence of intracranial infection,gastrointestinal bleeding,postoperative rebleeding between the observation group and the control group(P>0.05);(4)In the observation group,1 patient died during the follow-up period,and 3 patients died during the follow-up period.In the observation group,the mRS scores of 0,1,2,3,4,5,and 6 at 6 months after operation,the respective cases were 2,6,9.3,8,1,1;in the control group,the mRS scores of 0,1,2,3,4,5.and 6 at 6 months after operation,the respective cases were:1,3,8,8,8,3,3.There was no statistically significant difference in mRS scores between the two groups(P>0.05).Conclusions Small bone window craniotomy combined with neuroendoscopic surgery can reduce the length of surgery and reduce the incidence of postoperative pulmonary infection and epilepsy complication.