Posterior fossa hematoma removal

Posterior fossa hematoma is rare, accounting for 0.2% of brain injury and 2.6% of intracranial hematoma. Post-cranial fossa hematoma can occur in the dura mater, or in the subdural and brain, but the most common epidural hematoma, and can be associated with occipital hematoma above the transverse sinus (riding hematoma) . The injury is mostly caused by the occipital force, accompanied by occipital bone fracture, and the fracture line often crosses the transverse sinus or sinus. More epidural hematoma bleeding comes from the transverse sinus, sinus, meningeal blood vessels, sigmoid sinus and so on. Subdural hematoma mainly originates from the blood vessels on the surface of the cerebellum or the veins injected into the transverse sinus, and can also be derived from the damage of the transverse sinus and sinus. Hematoma in the cerebellum is caused by contusion of the cerebellar hemisphere. Hematoma is more common in one side, but it can also be seen on both sides. There are about 1/3 of the intracranial fossa hematoma combined with intracranial hematoma in other parts, especially the subdural hematoma at the frontal lobe of the heel site is the most common and should be noted. Treatment of diseases: posterior fossa hematoma Indication The volume of the posterior cranial fossa is small, and the compensatory function of the space-occupying lesion is limited. In addition, the hematoma is adjacent to the brain stem. Therefore, once the hematoma of the posterior fossa is diagnosed, except for the amount of bleeding <10ml, the patient is in good condition, it should be carried out as soon as possible. The surgery removes the hematoma. Contraindications For the amount of hematoma <10ml, the patient's consciousness is clear, and there is no manifestation of intracranial hypertension. Conservative therapy can be observed under close observation. Preoperative preparation 1. There must be a correct positioning diagnosis before surgery. In recent years, due to advances in imaging inspection technology, clinical applications such as CT, MRI, and DSA have become increasingly widespread. The relationship between the location of the lesion and the surrounding structure should be analyzed before surgery in order to select the appropriate surgical approach, to obtain the best exposure, avoid the important structure of the skull as much as possible, increase the safety of the operation and strive for good Effect. 2. Prepare the skin, wash your head with soap and water before surgery, and shave your hair. 3. Fasting before surgery. 4. Give phenobarbital 0.1g, atropine 0.4mg or scopolamine 0.3mg intramuscularly 1h before surgery. Surgical procedure 1. Incision: If it is a unilateral epidural or intracerebral hematoma, it is feasible to have a vertical incision in the ipsilateral suboccipital midline. If the hematoma is located in the midline or bilateral and subdural hematoma, a median vertical incision is made. The incision should exceed the occipital trochanter, or the suboccipital arc incision. In the case of a transsexual hematoma, a midline incision extending to the upper side of the screen may be used, or a median vertical incision may be made to the diseased side on the screen. 2. Peel off the suboccipital muscles to the sides, and use the posterior fossa retractor to retract the incision to detect the presence or absence of a fracture line. 3. First drill holes in the occipital scale near the fracture line, and gradually enlarge with a rongeur to form a bone window. You can also drill multiple holes around the hematoma, then use a rongeur to bite each bone hole and remove the occipital bone as a free bone flap. The size of the bone window can vary depending on the extent of the hematoma. 4. After seeing the epidural hematoma, the method of removing the hematoma is the same as the on-screen epidural hematoma. 5. Thoroughly stop bleeding after removing the hematoma. For hemorrhage on the dura mater, electrocoagulation can stop bleeding. For transverse sinus injury, the method of hemostasis refers to the treatment of sinus injury. 6. If the epidural hematoma is removed and the subdural is blue and the tension is still high, the dura mater should be cut radially to detect. If a subdural hematoma or cerebellar hematoma is found, it will be removed. 7. Whether the dural should be sutured should be determined according to the degree of swelling of the cerebellum after hematoma removal. In order to prevent postoperative brain swelling on the brain stem compression, the use of non-surgical suboccipital decompression. 8. After careful hemostasis, suture the incision. complication 1. The earliest and most serious complication after surgery is intracranial hemorrhage. A common cause is that hemostasis is not complete during surgery. Patients with concurrent intracranial hemorrhage, or delayed waking after surgery, or apathy, lethargy, headache, vomiting, seizures or re-coma after waking. The posterior cranial fossa is small, postoperative bleeding, edema, and its consequences are serious, so the hemostasis should be particularly careful during surgery. Vertebral artery, posterior inferior cerebellar artery and basilar artery injury, brain stem ischemia, the consequences are more serious. Therefore, there is no special reason after surgery for a long time, not awake or consciousness is gradually worsened, and signs of increased intracranial pressure such as slow pulse, elevated blood pressure, or new neurological symptoms should be paid attention to, should be highly alert to the skull The possibility of internal bleeding. CT examination should be performed in time when conditions are met, and the hematoma should be removed immediately after diagnosis. The earlier the surgery, the better the consequences. 2, any brain surgery, almost inevitably have brain edema, but the extent and scope are different. Minimizing injury during surgery is the most important preventive method. Postoperative head elevation, maintain airway patency, ensure oxygen supply, use dehydration drugs, hormones, large doses of vitamin C and cell activators, maintain water and electrolyte balance, prevent high fever, epilepsy, if necessary, cooling treatment, all help to alleviate Brain edema. 3, dura mater and muscle suture is not strict, the surgery area is not tightly wrapped, can cause cerebrospinal fluid leakage or pseudocyst, can cause intracranial and / or intraoperative infection, the mouth does not heal, the treatment is very difficult. Once found, the leak should be sutured in time. 4, the posterior cranial nerve injury can cause hoarseness, cough and difficulty swallowing.