Microsurgery treatment with small craniotomy lateral fissure approach for hypertensive basal ganglia intracerebral hemorrhage / 局解手术学杂志

Objective To investigate the efficacy of microsurgery treatment with small craniotomy lateral fissure approach for hyperten-sive basal ganglia intracranial hemorrhage. Methods From December 2013 to February 2015, 30 patients with hypertensive basal ganglia intracranial hemorrhage ( blood loss within 30~60 mL) were analyzed respectively. Summarized the methods and techniques of this microsur-gery treatment and analyzed its advantages and disadvantages compared with the traditional operation. Results The hematomas were excluded more than 90% which were proved by reexamination after opreation. There was one case of temporal lobe infarction,but there was no re-bleed case and death case. The recovery of consciousness is good, and the limb function and language function were improved by early rehabilitation treatment. Conclusion Microsurgery treatment with small craniotomy lateral fissure approach for hypertensive basal ganglia intracerebral hemorrhage has the advantages of minimal invasion,complete hematoma removal and low complication and disability rates, which is worthy of promotion and application.

Chronic Subdural Hematoma Treated by Small or Large Craniotomy with Membranectomy as the Initial Treatment

OBJECTIVE: There are few studies comparing small and large craniotomies for the initial treatment of chronic subdural hematoma (CSDH) which had non-liquefied hematoma, multilayer intrahematomal loculations, or organization/calcification on computed tomography and magnetic resonance imaging. These procedures were compared to determine which would produce superior postoperative results. METHODS: Between 2001 and 2009, 317 consecutive patients were surgically treated for CSDH at our institution. Of these, 16 patients underwent a small craniotomy with partial membranectomy and 42 patients underwent a large craniotomy with extended membranectomy as the initial treatment. A retrospective review was performed to compare the postoperative outcomes of these two techniques, focusing on improvement of neurological status, complications, reoperation rate, and days of post-operative hospitalization. RESULTS: The mean ages were 69.4+/-12.1 and 55.6+/-9.3 years in the small and large craniotomy groups, respectively. The recurrence of hematomas requiring reoperation occurred in 50% and 10% of the small and large craniotomy patients, respectively (p<0.001). There were no significant differences in postoperative neurological status, complications, or days of hospital stay between these two groups. CONCLUSION: Among the cases of CSDH initially requiring craniotomy, the large craniotomy with extended membranectomy technique reduced the reoperation rate, compared to that of the small craniotomy with partial membranectomy technique.

Chronic Subdural Hematomas : A Comparative Study of Three Types of Operative Procedures

OBJECTIVE: Several surgical procedures have been reported for the treatment of chronic subdural hematoma (CSDH). We compared the results of treatments for CSDH obtained from one burr-hole craniostomy with closed system drainage with or without irrigation, two burr-hole craniostomy with closed system drainage with irrigation, and small craniotomy with irrigation and closed-system drainage. METHODS: Eighty-seven patients with CSDH underwent surgery at our institution from January 2004 to December 2008. Our patients were classified into three groups according to the operative procedure; group I, one burr-hole craniostomy with closed system drainage with or without irrigation (n = 25), group II, two burr-hole craniostomy with closed system drainage with irrigation (n = 32), and group III, small craniotomy with irrigation and closed-system drainage (n = 30). RESULTS: Age distribution, male and female ratio, Markwalder's grade on admission and at the time of discharge, size of hematoma before and after surgery, duration of operation, Hounsfield unit of hematoma before and after surgery, duration of hospital treatment, complication rate, and revision rate were categories that we compared between groups. Duration of operation and hospitalization were only two categories which were different. But, when comparing burr hole craniostomy group (group I and group II) with small craniotomy group (group III), duration of post-operative hospital treatment, complication and recurrence rate were statistically lower in small craniotomy group, even though operation time was longer. CONCLUSION: Such results indicate that small craniotomy with irrigation and closed-system drainage can be considered as one of the treatment options in patients with CSDH.

The Operation of Acute Epidural Hematoma Through Small Craniotomy: Technical Note

We introduce a new operative method for acute epidural hematoma(AEDH) through small craniotomy. Between January 1999 and December 2001, 63 patients underwent craniotomy in our hospital to evacuate an acute posttraumatic epidural hematoma. Among these, we operated 18 patients with linear scalp incision and about 4 X 4cm sized small craniotomy. After operation, neurological symptoms were improved and there were no significant postoperative complications in all patients. This operative method is simple and less time consuming. It can be done under the local anesthesia and may be useful to all AEDH without severe brain swelling, subdural hematoma and intracerebral hematoma.

Small Craniotomy Lateral Fissure Approach and Technique of Micro-neurosurgery for Treatment of Morderate or Severe Intracerebral Hemorrhage from Putamen / 中国医师杂志

Objective To explore clinical effects of micro-nurosurgical treatment with small craniotomy lateral fissure approach to treat moderate or severe intraceral hemorrhage from putamen.Methods All of 51 patients with moderate or severe intracerebral hemorrhage were subjected to surgical treatment.Scalp incision was approximate the projection of lateral fissure on head,the diameter of the window of bone was about 3cm.The lateral fissure was opened by anatomizing sylvian cistern.After incising the cortex of insular,hemotoma was removed.Results 11 cases were dead,the mortality was 21 57%.The ADL was accepted as a standard means of describing outcome in these patients .2 cases,were subjected to Grade Ⅰ,6 cases for GradeⅡ,15 cases for GradeⅢ,8 cases for Grade Ⅳ,2 cases for Grade Ⅴ.Conclusions There is no significant difference of outcome between small craniotomy and craniotomy.(Lateral fissure approach) Transsylvian route is very directly for deep hemotomas,and brain injury caused by approach also is very light.