The current neurosurgical cerebral hemorrhage have been used a lot of holes in the keyhole to open surgery hematoma. Usually by keyhole and microscopic or endoscopic hematoma can be seen under a microscope or endoscope assisted keyhole hematoma help reduce the incidence of postoperative bleeding, surgical trauma, to better protect the nerve function in patients with mild (disease grade Ⅱ, Ⅲ) can get a better prognosis, with a good prospect. hypertensive intracerebral hemorrhage is the brain vascular mortality and morbidity in patients with the highest disease. With the development of CT, made the concept of minimally invasive surgery for the surgical treatment of hypertensive cerebral hemorrhage provides a very good condition. For individual patients, standardized treatment to achieve the best effect, has become a neurosurgeon goal. keyhole craniotomy techniques are used. According to the largest hematoma CT positioning options and levels from the cortex nearest the location for the keyhole, longitudinal incision of about 4cm, After the distraction of small mastoid retractors, and properly stop the bleeding. burr holes of a hole diameter of expanded bone window 2 ~ 3cm, bone margin bone wax to stop bleeding after the dural blood coagulation, suspended after the dura mater, was ; the word cut. select a relatively avascular cortical surface area, first thread a needle with a brain hematoma by CT-chip location and depth to proven intracerebral hematoma puncture site, direction and distance from the cortex. electrocoagulation after burning the cortex, in the the assistance of a small brain plate, protected with a wet cotton brain cerebral salt, and gradually into the hematoma cavity, the aid of the operating microscope to remove all or most of the hematoma (at least 80% or more). electrocoagulation of bleeding hematoma cavity with repeatedly washed with normal saline to flush liquid clear, drainage tube placed in a hematoma cavity, bone hole filled with gelatin sponge, followed by cranial off. There should be supplemented with intraventricular hemorrhage in the brain outdoor drainage. life after close monitoring of patients signs, especially blood pressure and prevent further bleeding. after regular use of lower intracranial pressure, bleeding, infection and nutritional support to prevent such treatment.
hypertensive intracerebral hemorrhage is the original basis of hypertension and cerebrovascular disease, the blood pressure further caused by a sudden jump. hematoma expansion in acute brain herniation and mechanical pressure caused by, resulting in local ischemic microvascular spasm, obstruction, necrosis, and hematoma in the decomposition of harmful substances, but also appeared around the hematoma, edema, degeneration, and necrosis. over the last bone craniotomy habits. small bone window hematoma drainage and hematoma can be sucked under direct vision, but it is difficult sucked deep hematoma, aspiration the brain, bleeding under direct vision problems, easy to create new damage and bleeding. The Skull hematoma aspiration in a non-surgery, trauma, though small, but the surgery is relative blindness, once difficult to completely remove the hematoma, have to rely on drugs urokinase into the hematoma cavity many times, it is difficult to promptly relieve intracranial hypertension, and increase the chance of intracranial infection. we used keyhole craniotomy, microsurgical technique or endoscopic-assisted microsurgical technique to achieve the goal of treatment of intracranial hematoma. it reduces the exposure time and area of brain tissue, led pull small and difficult to damage caused by the deep nuclei, especially for the hematoma cavity in the bottom of the handle has a good effect. through the individual design, selective reach the lesion, reducing the probability of postoperative neurologic dysfunction. In the course of the implementation of this operation, We conclude the following: (1) selected cases for the disease and hernia formation time is short, not deep or bleeding site is not particularly large amount of bleeding, midline shift is not particularly serious, most of the preoperative condition of Ⅳ level and below grade . (2) application of the surgical microscope during surgery, should be important to avoid injury of blood vessels and nerve structures. (3) surgery to remove the hematoma as possible, but not too clear all deliberately hematoma, especially near the middle side wall of the hematoma, hematoma (4). infratentorial posterior fossa hematoma, because of its particularity, accidentally using keyhole techniques. In addition severe midline shift, hematoma is large, old age, brain stem function has a serious injury, or serious disturbance of the vital signs combined patients who are contraindicated, not line keyhole surgery. (5) surgery to be carried out under general anesthesia, so patients can maintain the airway open and reduce aspiration, but should prevent postoperative awake irritability, causing blood pressure fluctuations, caused by re- bleeding. (6) technical manipulation of blood pressure to maintain the general level of the patient, repeatedly washed until the hematoma cavity to clarify and put in the drainage of the anterior cranial off. after application of drugs to control blood pressure, surgery sooner the better. For the first 2 postoperative days were not clear, recent estimates were not awake tracheotomy as soon as possible. This is the key to surgery less invasive, operating time is short, protect the brain and to reduce complications and improve the survival rate of patients . according to the disease characteristics, timely application of keyhole surgery, is a neurosurgeon for treatment of hypertensive intracerebral hemorrhage is the best choice.
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