Résumé
Objective:To observe the curative effect of stereotactic subtentorial approach for brainstem puncture and drainage on brain stem hemorrhage in elderly patients.Methods:The clinical data of elderly patients with brain stem hemorrhage admitted to the Department of Neurosurgery, Shangqiu First People 's Hospital from April 2018 to April 2022 were retrospectively analyzed.According to the inclusion and exclusion criteria, a total of 65 elderly patients with brainstem hemorrhage who were treated with stereotactic subtentorial approach for brain stem puncture and drainage, and had complete follow-up data within 90 days after operation were selected.The patient's data were reviewed.The operation time, hematoma clearance rate on the first day after operation, the drainage tube extraction of hematoma cavity, and the postoperative complications were recorded.The follow-up results at 30 days and 90 days after the operation were also recorded.The 30-day Glasgow outcome scale(GOS)was used to evaluate the short-term clinical outcomes of surviving patients, while the modified Rankin score was used to evaluate the neurological function recovery of surviving patients at 90 days.Results:The operation time of the 65 patients was 1.1-2.8 h, with an average of(1.9±0.4)h.On the first day after operation, CT scan showed that the hematoma clearance rate was(84.6±13.6)%.The drainage tube in hematoma cavity was removed within 3-5 days, and there was no puncture-related intracerebral hemorrhage or drainage tube-related intracranial infection after operation.During 30 days of follow-up, 9 patients died and 56 patients survived, with a survival rate of 86.2%.Among the surviving patients, 5 were temporarily in vegetative state and 51 were awake, with varoius degrees of disability.The preoperative hematoma volume of the surviving patients was significantly less than that of the dead patients, and the preoperative GCS score was significantly lower than that of the dead patients( Z=2.386, 2.009, P=0.017, 0.045). After 90 days of follow-up, 3 patients died and 53 survived, with a survival rate of 81.54%.Among the surviving patients, the neurological function of 22 patients recovered well, and the effective rate of clinical treatment was 41.51%. Conclusions:Stereotactic subtentorial approach for brain stem puncture and drainage is an effective and relatively safe surgical method for the treatment of brain stem hemorrhage in elderly patients.
Résumé
Objective:To analyze the correlation of serum homocysteine(Hcy)levels with hematoma absorption and cognitive function in elderly patients with cerebral hemorrhage.Methods:Clinical data of 80 elderly patients with cerebral hemorrhage admitted to our hospital from January 2017 to July 2019 were retrospectively analyzed.According to serum levels of Hcy(normal range: <15 μmol/L), 21 patients with serum Hcy<15 μmol/L were included in Group A, and 59 patients with Hcy≥15 μmol/L were included in Group B. General data(gender, age, hypertension, diabetes, bleeding part, bleeding volume, etc.), hematoma absorption and cognitive function were recorded and compared between the two groups.The correlation of serum Hcy levels with hematoma absorption and cognitive function in elderly patients with cerebral hemorrhage was analyzed by using Spearman correlation analysis.Results:There was no statistical difference in gender, age, hypertension, diabetes, bleeding location and bleeding volume between the two groups.The speed of hematoma absorption and scores of Montreal Cognitive Assessment(MoCA)were higher in Group A than in Group B[(0.4±0.1)ml/d vs.(0.3±0.1)ml/d, (19.6±4.6)points vs.(16.3±3.3)points, t=3.935 and 3.532, both P=0.000]. Spearman correlation analysis showed that serum Hcy level was negatively correlated with hematoma absorption and cognitive function in elderly patients with cerebral hemorrhage( r=-0.372 and-0.311, P=0.000 and 0.005), indicating that hematoma absorption and cognitive function were worse with the higher serum Hcy levels in elderly patients with cerebral hemorrhage. Conclusions:Serum Hcy levels change in elderly patients with cerebral hemorrhage.As serum Hcy levels increase, the risk for adverse events such as slow hematoma absorption and unsatisfactory improvement in cognitive function in patients increases accordingly.Serum Hcy levels play an important role in the occurrence and development of diseases in elderly patients with cerebral hemorrhage and can be used to evaluate the condition and prognosis of patients with cerebral hemorrhage.
Résumé
Objective To study the different effects on unilateral middle cerebral artery infarction with standard large trauma craniotomy and frontotemporal craniectomy and decompression treatment.Methods The clinical data of 56 patients with unilateral middle cerebral artery infarction were retrospectively analyzed.They were divided into the two groups according to the different operation methods,and compared the incidence of postoperative complications and GCS score after 1 week,GOS score after 1 month,and ADL score after 6 months and so on.Results The differences were significant between the two groups in incidence of postoperative complications [ incidence of rebleeding after the operation(A group 5 cases,B group 4 cases),showing of brain pools(A group 23 cases,B group 14 cases),lung infection(A group 7 cases,B group 13 cases),gastrointestinal bleeding(A group 8 cases,B group 17 cases),χ2 =0.579,4.703,8.606,7.081] and postoperative GCS score after a week[12 -15points(A group 5 cases,B group 2 cases),9-11points(A group 15 cases,B group 10 cases),5-8points(A group 6 cases,B group 8 cases),3-4points(A group 2 cases,B group 4 cases),death(A group 1 case,B group 3 cases),W value was 599.500,P=0.028] (all P0.05).Conclusion Standard large trauma craniotomy has features as decompression full,low early complication rate,and can improve the short-term efficacy of unilateral middle cerebral artery infarction in patients,and promote recovery.