Application of early time window modified stereotaxic aspiration in converting operation therapy on the specified acute epidural hematoma / 中国基层医药

Objective To discuss the application of early time window modified stereotaxic aspiration in converting operation therapy on the specified acute epidural hematoma.Methods 21 patients with the specified acute epidural hematoma were treated with early time window modified stereotaxic aspiration drainage,using YL-1 hematoma puncture needle with silica gel ventricular drainage tube.Results The successful rate of puncture was 100％.Hematoma was completely cleared in 19 cases.A small amount of epidural effusion was remained in 2 cases.1 case had concomitant rebleeding during the puncture,and shifted to craniotomy.Conclusion Early time window modified stereotaxic aspiration drainage is a minimally invasive,safe and effective treatment on the specified acute epidural hematoma when mastering the indications,timing and skills of puncture.

Recent progress of minimally invasive surgery for hypertensive intracranial hemorrhage / 第二军医大学学报

Hypertensive intracranial hemorrhage (HICH) has high incidence and mortality, causing great economic and health burden. However, HICH is the only subgroup of stroke that has no clear treatment standard. Though traditional craniotomy still enjoys popularity in treating HICH, yet no clear clinical evidence support its benefit to neuronal function and prognosis. Recently minimally invasive surgery (MIS) begin to show great advantage to treat HICH. This review presented the current situation and recent progress of common MIS procedures for HICH, including stereotactic aspiration, neuroendoscopic evacuation and fibrinolysis treatment.

The Clinical Study of Stereotaxic Aspiration in Spontaneous Intraparenchymal Hematoma

In a series of 91 patients underwent stereotaxic evacuation of spontaneous intraparenchymal hematoma during last 2 years; 15 had simple aspiration and 76 had urokinase irrigation gradually through the indwelling silastic catheter. Dosage of used urokinase was average 26,000u and duration was average 2.8 days. The average removed volume percent of the hematoma was 80.1+/-15.2%, eight out of 76 cases were performed urokinase irrigation revealed rebleeding; causes were overpressure during aspiration in 4 cases, blood dyscrasia in 3 cases, and fibrinolytic effect of urokinase in one case. High incidence of rebleeding were; thalamus(4 out of 16 cases; 25%) in location, before 6 hours(4 out of 19 cases; 21.1%) in operation time interval from ictus, below 10ml(4 out of 13 cases; 30.8%) in volume of the hematoma, but not correlated with amount of used urokinase. Causes of unsatisfactory removed cases were small hematoma, brain stem and thalamic hemorrhage and malposition of the catheter. Even in cases of combined ventricular hemorrhage, we didn't experienced hydrocephalus with urokinase irrigation. In 20 cases sampled randomly, osmolality of serum and aspirated liquefied hematoma were compared; the serum osmolality was 297.6+/-12mEq and osmolality of liquefied hematoma induced by urokinase was 304.7+/-11.3mEq. These findings strongly suggest that the surrounding interstitial fluid of the hematoma was shifted into the liquefied hematoma because of 7mEq difference of osmotic pressure. Over all good result(daily living activity) on discharge was 64.5% and mortality rate was 7.9%.

Comparative Clinical Analysis of Surgically Treated Spontaneous Intracranial Parenchymal Hematoma between with Stereotaxic Evacuation and Free-Hand Craniectomy

From Jun, 1983 to Sep, 1986, we operated 127 cases of spontaneous intracranical parenchymal hematoma. Among them, 88 cases were operated by stereotaxic evacuation of hematoma with computed B.R.W. system and 39 cases by free-hand craniectomy and leucotomy. We compared results of both methods. Results are as followings : 1) Nearly 90%(112 cases) were over 40 years old. 2) Prevalence of both sex were nearly same. 3) Hypertension cases on admission were 93 cases(73.2%). 4) Favorite anatomical locations were putamen(55 cases ; 43.3%), thalamus(32 cases ; 25.2%), subcortical(29 cases ; 22.8%), pontine, cerebellum in frequency. 5) Amount of removed hematoma were mostly 10-30ml and upper most case was 145ml. 6) Irrigation with urokinase were done in cases. 7) Surgical complication were 7 cases(5.5%) : 6 cases of reblecding : 1 case of ventriculitis. 8) Mortality of total cases were 26.0%(33 cases). 9) Comparative results between B.R.W. group and F.H.C. group were as followings ;(tab)B.R.W. group(tab)(tab)F.H.C. group(tab)(newline)Mortality(tab)13.60%(tab)(tab)28.20%(tab)(newline)(tab)AD(tab)DC(tab)AD(tab)DC(newline)Glasgow coma scale(tab)11.23+/-3.14(tab)12.72+/-3.87(tab)8.56+/-3.33(tab)10.97+/-4.93(newline)Motor power(tab)2.59+/-1.14(tab)3.44+/-1.27(tab)3.05+/-1.21(tab)3.32+/-1.53(newline)Motor of Putaminal Hx(tab)2.38+/-0.85(tab)3.13+/-1.00(tab)3.20+/-0.94(tab)3.00+/-1.41(newline)

A Clinical Analysis of 553 Cases of Hypertensive Intracerebral Hemorrhage

Authors analysed 553 CT-scan confirmed cases of hypertensive intracerebral hemorrhage. According to anatomical sites, incidence of intracerebral hemorrhage was greatest in the putamen with 45%, followed by 21.1%, in the thalamus, 16.3% in the subcortex, 5.9% in the cerebellum, 5.9% in the ventricles and 4.8% in the pons. According to hematoma sites, mortality rates were 23.3% in the putamen, 28.4% in the thalamus, 32.2% in the subcortex, 59.2% in the pons, 21.2% in the ventricles. The overall mortality rate was 28%.

Stereotaxic Evacuation of Brain Stem Hemorrhage

Usually cases of brain stem hemorrhage reveal high mortality and poor prognosis in spite of meticulous medical or surgical treatment. Recently we experienced stereotaxic evacuation of brain stem hemorrhage with Brown-Robert-Wells(B.R.W.) system in four cases. If there were residual hemorrhage after initial aspiration, those were evacuated with Urokinase irrigation via stereotaxically placed catheter in the hematoma. The entry point of our operation get on the crossing point of midpupillary line and 1cm behind coronal structure. Preliminary results : 1) Volume of removed hematoma : 5ml(average). 2) Dates of urokinase irrigation : 2 to 4 days after operation. 3) No hydrocephalus, no surgical mortality. 4) Average Glasgow coma scale was improved from 6 in preoperative state to 12 in postoperative state. 5) Operation was performed within 24 hours. 6) Advantages of our procedure. (1) Accurate, simple and safe. (2) Under local anesthesia. (3) Less traumatic procedure. (4) Could remove hematoma completely with Urokinase.