Effect of micro-assisted small bone flap craniotomy combined with Viewsite brain retractor on treatment of hypertensive intracerebral hemorrhage

doi:10.3877/cma.j.issn.2095-9141.2019.03.005

Abstract

Abstract:

Objective

To investigate the clinical effect of micro-assisted small bone flap craniotomy combined with Viewsite brain retractor on treatment of hypertensive intracerebral hemorrhage (HICH).

Methods

One hundred and eighteen patients diagnosed as HICH admitted to the Department of Neurosurgery, The 901^st Hospital of the Joint Logistics Support Force of PLA from June 2016 to June 2018. Among them, 53 patients had microsurgery with small bone flap craniotomy combined with Viewsite brain retractor (minimally invasive group), other 65 patients underwent routine craniotomy combined with cortical fistula (control group). The changes of perioperative parameters and postoperative complications were compared between the two groups. GOS score and modified Rankin scale (mRs) neurological function score were followed up 6 months later.

Results

Compared with the control group, the minimally invasive group had shorter operation time, less intraoperative hemorrhage, higher clearance rate of hematoma, shorter hospitalization time in NICU and higher GCS score at 14 d after operation, while the tracheotomy rate, edema area and pulmonary infection at 7 d after operation were significantly reduced (P<0.05), while the number of lateral ventricular drainage cases and indwelling time, intracranial infection rate and re-bleeding were significantly decreased (P<0.05). There was no significant difference in the rate (P>0.05). The GOS score and mRs score of the minimally invasive group were significantly better than those of the control group 6 months after operation (P<0.05).

Conclusion

Microscopically assisted small bone window combined with Viewsite brain retractor for HICH has the characteristics of less bleeding and trauma, complete removal of hematoma, and fewer complications. Postoperative neurological function recovery is good, and the clinical effect is remarkable.

Key words: Small bone window, Brain retractor, Microscope, Hypertensive intracerebral hemorrhage

Xiaogang Wu, Jiachuan Liu, Jinbiao Wang, Jie Yuan, Yongming Zhang. Effect of micro-assisted small bone flap craniotomy combined with Viewsite brain retractor on treatment of hypertensive intracerebral hemorrhage[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2019, 05(03): 150-154.

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Figures/Tables 5

References 15

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组别	例数	性别[例（%）]		年龄（岁）	血肿半球[例（%）]		血肿量（mL）	血肿所在部位[例（%）]			破入脑室[例（%）]	术前GCS评分
组别	例数	男	女	年龄（岁）	左	右	血肿量（mL）	基底节区	脑叶	丘脑	破入脑室[例（%）]	术前GCS评分
对照组	65	36（55.38）	29（44.62）	62.92±6.21	29（44.62）	36（55.38）	37.63±8.52	46（70.77）	8（12.31）	11（16.92）	25（38.46）	8.46±1.72
微创组	53	30（56.60）	23（43.40）	64.36±5.72	24（45.28）	29（54.72）	35.89±7.96	38（71.70）	6（11.32）	9（16.98）	21（39.62）	7.91±1.53
t/χ²值	?	0.176		0.396	0.114		1.216	0.466			0.215	0.694
P值	?	0.852		0.513	0.762		0.237	0.814			0.762	0.583

组别	例数	性别[例（%）]		年龄（岁）	血肿半球[例（%）]		血肿量（mL）	血肿所在部位[例（%）]			破入脑室[例（%）]	术前GCS评分
组别	例数	男	女	年龄（岁）	左	右	血肿量（mL）	基底节区	脑叶	丘脑	破入脑室[例（%）]	术前GCS评分
对照组	65	36（55.38）	29（44.62）	62.92±6.21	29（44.62）	36（55.38）	37.63±8.52	46（70.77）	8（12.31）	11（16.92）	25（38.46）	8.46±1.72
微创组	53	30（56.60）	23（43.40）	64.36±5.72	24（45.28）	29（54.72）	35.89±7.96	38（71.70）	6（11.32）	9（16.98）	21（39.62）	7.91±1.53
t/χ²值	?	0.176		0.396	0.114		1.216	0.466			0.215	0.694
P值	?	0.852		0.513	0.762		0.237	0.814			0.762	0.583

组别	例数	手术时间（h）	术中出血量（mL）	血肿清除率（%）	侧脑室外引流[例（%）]	侧脑室引流管留置时间（d）	再出血[例（%）]	NICU住院时间（d）
对照组	65	2.79±0.38	226.72±38.54	68.72±7.05	16（24.62）	6.80±1.17	3（4.62）	12.85±2.76
微创组	53	1.68±0.21	88.36±19.29	90.85±8.13	12（22.64）	7.12±1.02	2（3.77）	7.62±1.83
t/χ²值	?	21.338	13.487	16.924	0.679	0.933	0.095	9.362
P值	?	0.001	0.001	0.001	0.451	0.617	0.895	0.012

组别	例数	手术时间（h）	术中出血量（mL）	血肿清除率（%）	侧脑室外引流[例（%）]	侧脑室引流管留置时间（d）	再出血[例（%）]	NICU住院时间（d）
对照组	65	2.79±0.38	226.72±38.54	68.72±7.05	16（24.62）	6.80±1.17	3（4.62）	12.85±2.76
微创组	53	1.68±0.21	88.36±19.29	90.85±8.13	12（22.64）	7.12±1.02	2（3.77）	7.62±1.83
t/χ²值	?	21.338	13.487	16.924	0.679	0.933	0.095	9.362
P值	?	0.001	0.001	0.001	0.451	0.617	0.895	0.012

组别	例数	术后7 d水肿面积（mL）	气管切开[例（%）]	肺部感染[例（%）]	颅内感染[例（%）]	术后14 dGCS评分
对照组	65	19.73±2.86	28（43.08）	26（40.00）	6（9.23）	9.67±1.76
微创组	53	11.09±1.35	16（30.19）	14（26.42）	4（7.55）	11.94±1.95
t/χ²值	?	8.164	12.865	15.238	0.273	9.362
P值	?	0.007	0.001	0.001	0.699	0.001

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