微骨窗经侧裂-岛叶人路治疗高血压壳核出血的临床研究

目的 探讨微骨窗经侧裂-岛叶入路血肿清除术治疗高血压壳核出血的临床疗效.方法 选择高血压壳核出血患者25例.出血量60～120ml,平均83ml.所有患者就诊时均尚未出现脑疝体征.行微骨窗皮质造瘘血肿清除术13例,行微骨窗经侧裂-岛叶人路12例.结果 行微骨窗皮质造瘘的13例患者术后72h内清醒8例,2周内清醒2例,持续昏迷3例,无术后30d内死亡者;行微骨窗侧裂-岛叶入路的12例患者全部在72h内清醒,1例术后2周死于肾衰竭.术后随访2～24个月.平均11个月,两组均无预后良好者.左侧优势半球血肿患者经侧裂入路者,语言功能好于经皮质造瘘者.结论 对于适当的病例选择微骨窗经侧裂-岛叶入路治疗,可有利于追求更好的功能恢复.

Surgical treatment of hypertensive putaminal hematomas through transsylvian-insular approach

Objective To investigate the clinical effects of hypertensive putaminal hematomas(HPH) through transsylvian-insular approach. Methods Twenty-five cases of HPH with volume of hematomas from 60 to 120ml were enrolled. The CT classifications were all extra-capsular type, and all the cases have no signs of herniation on admission. Thirteen cases received transcortical surgical treatment and 12 cases transsylvian-insular approach to remove the hematomas. Results The cases who received transsylvian-insular approach had to better neurological condition after surgery and in follow-up. Conclusions Transsylvian-insular approach is a choice for a more ideal prognosis in patients with limited extra-capsular type hematoma and relatively better preoperative neurological condition.