Decompressive craniectomy with hematoma evacuation for large hemispheric hypertensive intracerebral hemorrhage.
Decompressive craniectomy with hematoma evacuation for large hemispheric hypertensive intracerebral hemorrhage.
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DOI：
10.1007/978-3-7091-1434-6_53
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发表时间：
2013-01-01
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影响因子：
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通讯作者：
Shima, Katsuji
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作者：
Takeuchi, Satoru;Takasato, Yoshio;Shima, Katsuji
半球高血压性脑出血(ICH)死亡率高。去骨瓣减压术(DC)通常用于治疗重型颅脑损伤、动脉瘤性蛛网膜下腔出血和半球脑梗塞。然而，DC对半球高血压性脑出血的影响尚不清楚。为探讨DC治疗半球高血压性脑出血的疗效，我们回顾了21例接受DC治疗的半球高血压性脑出血患者的临床和放射学表现。其中男性11例，女性10例，年龄22~75岁，平均56.6岁。术前格拉斯哥昏迷评分3~13分，平均6.9分。血肿体积33.4~98.1毫升，平均74.2毫升，10例位于基底节，11例位于皮质下。11例患者观察到脑室扩张。在DC术后并发症方面，10例患者术后发生脑积水，3例患者出现脑膜炎。6例预后良好，15例预后较差。病死率为10%。经统计学分析，预后良好组入院时GCS评分显著高于预后不良组(P=0.029)。我们的结果表明，DC血肿清除术可能是一种有效的手术方式，适用于部分大脑半球高血压脑出血患者。
Hemispheric hypertensive intracerebral hemorrhage (ICH) has a high mortality rate. Decompressive craniectomy (DC) has generally been used for the treatment of severe traumatic brain injury, aneurysmal subarachnoid hemorrhage, and hemispheric cerebral infarction. However, the effect of DC on hemispheric hypertensive ICH is not well understood. To investigate the effects of DC for treating hemispheric hypertensive ICH, we retrospectively reviewed the clinical and radiological findings of 21 patients who underwent DC for hemispheric hypertensive ICH. Eleven of the patients were male and 10 were female, with an age range of 22-75 years (mean, 56.6 years). Their preoperative Glasgow Coma Scale scores ranged from 3 to 13 (mean, 6.9). The hematoma volumes ranged from 33.4 to 98.1 mL (mean, 74.2 mL), and the hematoma locations were the basal ganglia in 10 patients and the subcortex in 11 patients. Intraventricular extensions were observed in 11 patients. With regard to the complications after DC, postoperative hydrocephalus developed in ten patients, and meningitis was observed in three patients. Six patients had favorable outcomes and 15 had poor outcomes. The mortality rate was 10 %. A statistical analysis showed that the GCS score at admission was significantly higher in the favorable outcome group than that in the poor outcome group (P = 0.029). Our results suggest that DC with hematoma evacuation might be a useful surgical procedure for selected patients with large hemispheric hypertensive ICH.