ABSTRACT
Objective:To explore and analyze the selection of surgical methods for supratentorial intracerebral hemorrhage.Methods:A total of 260 patients with spontaneous intracerebral hemorrhage who underwent surgery in Department of Neurosurgery, Suzhou Hospital Affiliated to Nanjing Medical University from January 2017 to December 2021 were included in the study by retrospective case analysis. According to different surgical methods, they were divided into three groups: large bone flap group ( n=116), conventional bone flap group( n=89)and stereotactic group( n=55). The large bone flap group underwent standard supratentorial large bone flap craniotomy, the conventional bone flap group underwent conventional bone flap craniotomy, and the stereotactic group underwent stereotactic hematoma puncture suction + drainage. Clinical indicators such as operation time, intraoperative bleeding, pulmonary infection, length of hospital stay, and Glasgow outcome scale (GOS) at 6 months of postoperative follow-up, and the proportion of good prognosis (GOS 4-5) were calculated. Measurement data with normal distribution were expressed as mean±standard deviation( ± s), count data were expressed as cases and percentages (%). Results:In the large bone flap group, the operation time, intraoperative bleeding, hospital stay, pulmonary infection, postoperative rebleeding were(193±24) min, (625±65) mL, (46±11) d, 102 patients(87%), 9 patients(7.8%), and (124±17) min, (297±35) mL, (32±9) d, 29 patients(33%), 4 patients(4.4%)in the conventional bone flap group, and (73±11) min, (53±15) mL, (21±4) d, 10 patients(18%), 2 patients(3.6%)in stereotactic group. All patients were followed up for 6 months, and 165 patients (63.5%) had good prognosis (GOS 4-5), including 36 patients (31%) in the large bone flap group, 82 patients (93.2%) in the conventional bone flap group, and 47 patients (85.5%) in the stereotactic group.Conclusion:Standard large craniectomy has sufficient effect of decompression, and is suitable for serious life threatening hematoma; Conventional craniotomy has advantages in the treatment of secondary intracerebral hemorrhage. Stereotactic surgery has the characteristics of short operation time, less intraoperative bleeding, short hospital stay and low incidence of pulmonary infection, which is worthy of promotion in the treatment of primary intracerebral hemorrhage.