探讨神经内镜联合Viewsite脑牵开器手术治疗重度脑室出血（IVH）铸型的临床效果。

回顾性分析解放军联勤保障部队第九〇一医院神经外科自2018年1月至2021年1月收治的26例重度IVH铸型患者的临床资料，其中12例患者行神经内镜联合Viewsite脑牵开器经侧脑室额角入路手术清除脑室内血肿，为手术组；14例患者采用侧脑室额角钻孔置管外引流，为对照组。对比2组患者术后6 h、3 d的血肿清除率、术后6 h Graeb评分和脑室颅腔比（VCR）值的变化、引流管留置时间、甘露醇使用量及使用时间、神经重症监护单元（NICU）住院时间、术后14 d GCS评分的变化、术后并发症（再出血、肺部感染、颅内感染及迟发性脑积水）的发生率。术后随访6个月，采用改良的Rankin量表（mRs）及额叶功能评定量表（FAB）评估2组患者的额叶功能损害程度。

相较于对照组，手术组患者术后血肿残余量减少，术后6 h Graeb评分及VCR值降低，引流管留置时间缩短，甘露醇使用减少，NICU住院时间缩短及术后2周GCS评分提高，术后颅内感染和迟发性脑积水的发生率降低，术后6个月mRs神经功能评分提高，差异均有统计学意义（P<0.05），而2组患者术后再出血和肺部感染的发生率以及FAB评分比较，差异无统计学意义（P>0.05）。

神经内镜联合Viewsite脑牵开器手术治疗重度IVH铸型能够快速清除脑室内血肿，尽早恢复脑室再通，降低脑室系统的被动扩张，改善患者的生存质量。

To explore the clinical effect of neuroendoscope combined with Viewsite brain retractor in the treatment of severe intraventricular hemorrhage (IVH) casting.

Twenty-six patients with severe IVH cast treated in the Neurosurgery Department of the 901^st Hospital of the Joint Logistics Support Force of PLA from January 2018 to January 2021 were analyzed retrospectively. Among them, 12 patients underwent neuroendoscopy combined with Viewsite brain retractor through the lateral ventricular frontal angle approach to remove intraventricular hematoma as the operation group; 14 patients were treated with lateral ventricle frontal angle drilling and external drainage as the control group. The postoperative hematoma clearance rate at 6 h and 3 d, postoperative 6 h Graeb scores, changes in the ventricular-cranial cavity ratio (VCR), drainage tube retention time, mannitol dosage and duration, length of stay in neurointensive care unit (NICU) hospitalization and changes in postoperative 14 d GCS scores were compared between the two groups. Furthermore, the incidence of postoperative complications (rebleeding, pulmonary infection, intracranial infection, and delayed hydrocephalus) were compared between the two groups. Postoperative follow-up for 6 months, and the degree of frontal function impairment was assessed by modified Rankin scale (mRs) and frontal lobe frontal assessment battery (FAB) scores.

Compared with the control group, patients in the operation group had less residual hematoma, the Graeb score and VCR value at 6 h after operation were reduced, the indwelling time of drainage tube was shortened; the use of mannitol was reduced, the length of stay in NICU was shortened; the GCS score was improved at 2 weeks after operation; the incidence of postoperative complications (including intracranial infection and delayed hydrocephalus) was reduced, and the mRs neurological function score was improved at 6 months after operation, the differences were all statistically significant (P<0.05). There was no significant difference in the incidence of postoperative rebleeding, pulmonary infection and FAB score between the two groups (P>0.05).

Neuroendoscopy combined with Viewsite brain retractor for the treatment of severe IVH cast can clear the intraventricular hematoma early and quickly, achieve ventricular recanalization early, reduce the passive expansion of the ventricular system, and improve the quality of life of patients.