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Objective:To investigate the efficacy of minimally invasive puncture and drainage versus small bone window craniotomy in the treatment of hypertensive basal ganglia hemorrhage. Methods:Seventy-three patients with hypertensive basal ganglia hemorrhage who received treatment in Hequ County People's Hospital from April 2018 to December 2020 were included in this study. They were divided into a minimally invasive puncture and drainage group ( n = 38) and a small bone window craniotomy group ( n = 35) according to surgical methods. Clinical efficacy and postoperative complications were compared between the two groups. Results:At 3 months post-surgery, the National Institutes of Health Stroke Scale score in the minimally invasive puncture and drainage group was significantly lower than that in the small bone window craniotomy group [(3.58 ± 1.23) points vs. (6.87 ± 0.97) points, t = 12.62, P < 0.001]. Barthel index in the minimally invasive puncture and drainage group was significantly higher than that in the small bone window craniotomy group [(62.15 ± 6.78) points vs. (43.15 ± 7.15) points, t = 11.65, P < 0.001]. The total response rate in the minimally invasive puncture and drainage group was significantly higher than that in the small bone window craniotomy group [92.11% (35/38) vs. 74.3% (26/35), χ2 = 4.21, P < 0.05]. The incidence of complications in the minimally invasive puncture and drainage group was significantly lower than that in the small bone window craniotomy group [5.2% (2/38) vs. 25.7% (9/35), χ2 = 6.18, P < 0.05]. Conclusion:Minimally invasive puncture and drainage have better clinical efficacy and fewer postoperative complications in the treatment of hypertensive basal ganglia hemorrhage than small bone window craniotomy. Therefore, minimally invasive puncture and drainage for the treatment of hypertensive basal ganglia hemorrhage are worthy of clinical promotion.
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Objective To compare the efficacy of different decompressions treatment combined with posterior cervical fusion and internal fixation treatment on Chiari Ⅰ malformation associated with syringomyelia and atlantoaxial instability.Methods From January 2016 to October 2017,36 cases of Chiari Ⅰ malformation associated with syringomyelia and atlantoaxial instability in Linfen People's Hospital were selected in the research.The patients were divided into two groups according to random number table method,with 18 cases in each group.The observation group was given decompression of posterior fossa of small bone window + cerebellar tonsillectomy + posterior cervical fusion and internal fixation treatment.The control group was given traditional decompression of posterior fossa + posterior cervical fusion and internal fixation treatment.The efficacy,complications occurred within 1 year after operation,JOA score and spinal cord cavity size at different time points before and after operation of the two groups were compared.Results The total effective rate of the observation group [94.44％ (17/18)] was slightly higher than that of the control group [88.89％ (16/18)] (x2 =1.957,P ＞ 0.05).The total effective rate of the observation group at 1 year after operation was 88.89％ (16/18),which was significantly higher than that of the control group [72.22％ (13/18)] (x2 =3.498,P ＜ 0.05).The incidence rate of complications of the observation group at 1 year after operation was 11.11％ (2/18),which was significantly lower than that of the control group [38.89％ (7/18)] (x2 =11.685,P ＜ 0.05).The JOA scores at discharge[(15.97 ± 1.25) point] and 1 year after operation[(15.53 ± 1.19) point] of the observation group were significantly higher than those of the control group [(14.21 ± 1.18) point,(14.06 ±1.15) point] (t =3.815,3.706,all P ＜ 0.05).The spinal cord cavity size at discharge [(2.13 ± 0.64) mm] and 1 year after operation [(2.28 ± 0.69) mm] of the observation group were significantly higher than those of the control group [(3.41 ±0.76)mm,(3.45 ±0.78)mm] (t =5.743,5.511,all P＜0.05).Conclusion The long-term efficacy of decompression of posterior fossa of small bone window + cerebellar tonsillectomy + posterior cervical fusion and internal fixation treatment on Chiari Ⅰ malformation associated with syringomyelia and atlantoaxial instability is remarkable,the recovery of spinal cord function and syringomyelia is well and the postoperative complications incidence is relatively low,which is worthy of popularization and application.
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Objective@#To compare the efficacy of different decompressions treatment combined with posterior cervical fusion and internal fixation treatment on Chiari I malformation associated with syringomyelia and atlantoaxial instability.@*Methods@#From January 2016 to October 2017, 36 cases of Chiari I malformation associated with syringomyelia and atlantoaxial instability in Linfen People's Hospital were selected in the research.The patients were divided into two groups according to random number table method, with 18 cases in each group.The observation group was given decompression of posterior fossa of small bone window + cerebellar tonsillectomy + posterior cervical fusion and internal fixation treatment.The control group was given traditional decompression of posterior fossa + posterior cervical fusion and internal fixation treatment.The efficacy, complications occurred within 1 year after operation, JOA score and spinal cord cavity size at different time points before and after operation of the two groups were compared.@*Results@#The total effective rate of the observation group [94.44%(17/18)] was slightly higher than that of the control group [88.89%(16/18)] (χ2=1.957, P>0.05). The total effective rate of the observation group at 1 year after operation was 88.89%(16/18), which was significantly higher than that of the control group [72.22%(13/18)] (χ2=3.498, P<0.05). The incidence rate of complications of the observation group at 1 year after operation was 11.11%(2/18), which was significantly lower than that of the control group [38.89%(7/18)](χ2=11.685, P<0.05). The JOA scores at discharge[(15.97±1.25)point] and 1 year after operation[(15.53±1.19)point] of the observation group were significantly higher than those of the control group[(14.21±1.18)point, (14.06±1.15)point](t=3.815, 3.706, all P<0.05). The spinal cord cavity size at discharge [(2.13±0.64)mm] and 1 year after operation[(2.28±0.69)mm] of the observation group were significantly higher than those of the control group [(3.41±0.76)mm, (3.45±0.78)mm](t=5.743, 5.511, all P<0.05).@*Conclusion@#The long-term efficacy of decompression of posterior fossa of small bone window + cerebellar tonsillectomy + posterior cervical fusion and internal fixation treatment on Chiari I malformation associated with syringomyelia and atlantoaxial instability is remarkable, the recovery of spinal cord function and syringomyelia is well and the postoperative complications incidence is relatively low, which is worthy of popularization and application.
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Objective To analyze the risk factors of postoperative rebleeding after hypertensive cerebral hemorrhage,and provide a basis for clinical prevention of postoperative recurrent hemorrhage. Methods The clinical data of 413 patients with hypertensive intracerebral hemorrhage in our hospital from January 2007 to December 2017 were retrospectively analyzed.The possible correlation factors of postopera-tive recurrent hemorrhage and the high-risk factors were collected and summarized. Results According to univariate unconditional logistic regression analysis, there was a significant correlation between systolic blood pressure, GCS score, bleeding volume, coagulation dysfunction and the use of sedative analgesics with the hypertensive cerebral hemorrhage after surgery(P<0.05);they were also the risk factors of post-operative rebleeding after hypertensive cerebral hemorrhage according to the multivariate unconditional logistic regression analysis (P<0.05). Conclusion The results indicate that there are many factors influencing postoperative rebleeding in patients with hypertensive cerebral hemorrhage.In the perioperative period,higher systolic blood pressure,deeper consciousness disorder,more bleeding,and coagulation dysfunction are independent factors influencing postoperative re-bleeding, and more attention should be paid to it.
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Objective To investigate the effect of small bone window hematoma ventriculoscope for clinical treatment of hypertensive cerebral hemorrhage.Methods From January 2014 to June 2017,80 patients with hypertensive cerebral hemorrhage in Zhejiang Rongjun Hospital were selected and randomly divided into two groups according to the digital table,with 40 cases in each group.The control group underwent conventional craniotomy hematoma removal surgery,the observation group received small bone window hematoma ventriculoscope treatment.The operation situation,hospitalization time,clinical efficacy and nerve function defect score,ADL score,the incidence rate of complications were compared between the two groups.Results There was no statisticall significant difference in operation time between the two groups (t =0.284,P ＞ 0.05).The amount of intraoperative bleeding of the observation group was (35.47 ± 10.69) mL,which was significantly less than (96.85 ± 27.54) mL of the control group (t =13.141,P ＜ 0.05).The hospitalization time of the observation group was significantly shorter than the control group[(8.52 ±2.31) d vs.(11.79 ± 3.05) d] (t =5.405,P ＜ O.05).The total effective rate of observation group was 92.5 ％ (37/40),which was higher than 75.0％ (30/40) in the control group (x2 =4.501,P ＜ 0.05).After treatment,the neural function defect score and daily life ability score of the observation group were (17.59 ± 2.98) points,(82.45 ±6.03) points,respectively,which were significantly higher than those of the control group[(22.17 ± 3.06) points,(73.21 ± 5.12) points] (t =6.782,7.388,all P ＜ 0.05).The incidence rate of complications of the observation group was 5.0％ (2/40),which was significantly lower than 20.0％ (8/40) in the control group (x2 =4.114,P ＜ 0.05).Conclusion Small bone window craniotomy evacuation of hematoma in the treatment of hypertensive cerebral hemorrhage,not only has significant clinical efficacy,but also has the advantages of less intraoperative blood loss,rapid postoperative recovery,less complications and so on.
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Objective To explore the therapeutic effects of different surgery methods on early hypertensive intracerebral hemorrhage(HICH)in basal ganglia region in elderly patients and on prognostic factors analysis.Methods 89 elderly patients with early HICH were randomly divided into four groups according to surgery methods and whether their ICP was monitored.Group A(n=21)was given minimally invasive hematoma drainage,group B(n=23)was given small bone window for removal of hematoma,group C(n=21)and group D(n=24)was given ICP monitoring and corresponding management of ICP on the basis of group A and group B,respectively.The changes of intracranial pressure before and after operation,prognosis and post-operative complications were compared.Results The intracranial pressure was significantly decreased at 3rd day,7th day after operation in group C and D as compared with those in group A and B at the same time points(F=11.76,P<0.05),and the score of GCS was also higher in group C and D at 7th day after operation than in group A,B at the same time points(F=4.72,P<0.05).At 14th and 28th day after operation,the score of GCS was higher in group C than in group A and B(F=19.24,P<0.05),and higher in group C than in group D at 28th day after operation(F=22.26,P<0.05).The dosage of mannitol was significantly lower in group C and group D than in group A and group B(F=18.87,P<0.05).The incidence rate of post-operative complications was 14.3% in group C vs.28.6% in group A(P<0.05)and 20.8% in group D vs.47.8% in group B(χ2=7.04,P<0.05).The proportion of a good recovery and a light disability was significantly higher in group C and D(76.2% and 75.0%)than in group A and B(42.9% and 39.1%)respectively(χ2=14.99,all P<0.05).Conclusions Minimally invasive hematoma drainage shows the advantages of small trauma and a few complications for the treatment of elderly patients with early HICH,and its combination with ICP can early change intracranial pressure and further improves the prognosis.
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Objective To explore the surgical indication,key point and curative effect of small bone window in removing the frontal brain contusion and basal ganglia hematoma.Methods The clinical data of 118 patients with frontal cerebral contusion (38 cases) or basal ganglia hematoma (80 cases) were retrospectively analyzed,and the patients were given small bone window surgery.Results The postoperative curative effect was evaluated by daily life activities Barthel index.In 118 patients,56 cases (47.5％) were postoperative independent (Barthel index 100 scores),34 cases (28.8％) were mild dependence (Barthel index 75-95 scores),16 cases (13.6％) were moderate dependence (Barthel index 50-70 scores),10 cases (8.5％) were severe and totally dependence (Barthel index 0-45 scores),and 2 cases (1.7％) were death.Conclusion Small bone window in removing the frontal brain contusion and basal ganglia hematoma has small trauma,fully removed lesions,shorter operation time,fewer complications,quicker recovery,no skull repair,and lower mortality and disability rate.
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Objective To study the clinical effect of microsurgical treatment via lateral fissure approach on hypertensive basal ganglia hemorrhage.Methods Small bone flap via lateral fissure approach were applied to remove basal ganglia hematoma.Thirty two cases were recruited in the retrospective analysis.Results By head CT scan follow-up 24 h post operation,over 80％ percent of hematoma was successfully removed in 28 cases and over 40％ of hematoma was resided in 4 case.Patients were followed up for 3 - 6 months,according to the ADL (ADL)classification,the outcomes were:Grade Ⅰ in 4 cases( 12.5％ ),grade Ⅱ in 13 cases(40.6％ ),grade Ⅲ in 12 cases (37.5％)and grade Ⅳ in 3 cases (9.4％).No death occurred.Conclusion Small window approach on lateral fissure for microsurgical operation of hypertensive basal ganglia hemorrhage is a less invasive procedure with good surgical exposure and homeostasis.Neurological function was well recovered after surgery.
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Objective To study the different effects of hypertensive putamen hemorrhage with two different treatments of decompressive craniotomy and small bone window(keyhole) surgery. Methods Retrospective analysis of 120 cases of hypertensive putamen hemorrhage in patients with operation data was carried out. They were randomly divided into two groups according to the different surgical procedure, and then compared the incidence of postoperative complications, close and long-term effects and so on. Results There was no significant difference in early complication rate and postoperative GOS score after a week between two groups(P＞0.05). The difference was significant between two groups in close and long-term effects (P ＜ 0.05 ). Conclusion Small bone window (keyhole)surgery had characteristics such as surgical time-saving ,less damage and more rapid recovery with removal of hematoma, and made played a significant role in promoting the recovery of close and long-term effects with patients.