intracranial hematoma removal

It is rare in traumatic hematoma, accounting for about 10% of intracranial hematoma. Can be divided into shallow and deep two types. The former is a complex intracerebral hematoma, which often coincides with the amount of the occipital force and the contralateral cerebral contusion. Hemorrhage is caused by the expansion of the hematoma formed by the ruptured cerebral cortical vasculature, often accompanied by acute subdural hematoma. Can also be seen in the depression caused by the fracture. The latter is a simple intracerebral hematoma caused by rupture of deep blood vessels in the brain, with no obvious damage or only mild contusion on the surface of the brain. Indication 1. CT diagnosis is clear, and there is increased intracranial pressure or focal symptoms. 2. After the subdural or epidural hematoma is removed, the intracranial pressure is still high, the brain bulges outward or the cerebral cortex has local contusion, and the palpation has fluctuations. 3. The hematoma is located in the deep part of the important functional area. After the puncture is attracted, the hematoma is not reduced, and the intracranial pressure is not improved. Contraindications 1. Simple intracerebral hematoma, small amount of hematoma, and no increase in intracranial pressure or only mild increase. 2. After the puncture and attraction, the hematoma has not been enlarged, and the increase in intracranial pressure has been improved. 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. Select the hemorrhage closest to the surface and avoid the craniotomy of the important functional area. 2. If there is a hematoma outside the epidural or subdural, it should be removed first. 3. Check the surface of the brain for contusion. In the location of heavy contusion, a shallow intracerebral hematoma can often be found. If hematoma cannot be seen, electrocoagulation can be performed at the puncture site of the contusion, and then the cerebral needle is gradually puncture into the brain to determine the location of the hematoma. If there is no contusion, puncture according to the direction of the hematoma determined by CT. After determining the location of the deep intracerebral hematoma, the puncture site is selected on the cerebral gyrus of the non-functional area, and the cerebral cortex is cut 2 to 3 cm after electrocoagulation, and then gradually separated into the deep brain by the brain plate and the aspirator in the direction of puncture. Directly into the hematoma cavity. 4. Use a suction device to remove the hematoma, if there is active bleeding to coagulate to stop bleeding. The softened, necrotic brain tissue should also be removed. 5. After complete hemostasis, the drainage tube is built in the hematoma cavity (or not), and the incision is closed. complication 1. Postoperative recurrent hematoma and delayed hematoma. It should be discovered and disposed of in time. 2. Secondary brain swelling and cerebral edema should be properly controlled. 3. Long-term coma patients are prone to pulmonary infection, water and electrolyte balance disorders, hypothalamic dysfunction and malnutrition, etc., should be treated accordingly.