Brain stem hematoma removal

Brain stem hematoma often occurs in patients aged 40 to 50 years. The course of disease progression can be divided into three types: 1 acute stroke type, that is, rapid deep coma, followed by brain stem dysfunction and failure, and more than 48 hours of death; 2 course of disease Chronic progressive aggravation, similar to brain stem tumors; 3 clinical symptoms are intermittent changes, similar to brain stem encephalitis. Before CT scanning, it is difficult to make a clinical diagnosis of brain stem hematoma, and most of them are diagnosed at autopsy. Cerebral angiography is helpful in diagnosing brain stem hemorrhage. After CT scan is applied to the clinic, the diagnosis of the disease is rapid and accurate, and the treatment strategy can be formulated according to different situations in time, thereby improving the cure rate of the disease. In the past, most of the brain stem hemorrhage was treated conservatively, and a few surgical healers were mostly found in brain stem tumor surgery. In the past 50 years, 46 cases of brain stem hematoma have been successfully treated by craniotomy or stereotactic surgery. Treatment of diseases: hemorrhagic stroke brain stem tumor Indication 1. CT scan hematoma volume more than 5ml, brain stem pressure is obvious, clinical symptoms are progressively worse. 2. Brain stem hematoma is close to the surface of the brain stem, and there is a risk of breaking into the ventricle or subarachnoid space. 3. Although the hematoma in the brainstem is small, the surrounding edema is serious, and the brain stems are progressively aggravated by the pressure signs, and the pressure is not relieved. Contraindications 1. Hematoma <3ml, the patient is in good condition, non-surgical treatment can cure. 2. The patient is old and frail, and the main organs of the whole body are severely impaired or failing. 3. In the late stage of cerebral palsy, the pupils of both sides are dilated, and the pathological breathing or breathing has stopped. Preoperative preparation CT scans to determine the location and size of the hematoma, providing a basis for surgical access. Surgical procedure According to the different parts of the brain stem hematoma, three different approaches of the infraorbital, cerebellar cerebral horn and the fourth ventricle are generally used, which are described as follows. 1. Under the way Used to remove one side of the midbrain hematoma. The method is: 1 horseshoe-shaped incision on one side of the pillow, the base is on the outer side, and the flap is free to turn to the temporal side. 2 drill 4 holes, form the bone flap and turn to the temporal side. 3 Dural valvular incision, turned to the side of the transverse sinus, lift the occipital lobe, when the lower anastomotic vein remains difficult, it can be cut after electrocoagulation. Cut the cerebellum to reach the midline of the free edge, expose the left side of the cerebral ventricle closest to the hematoma, or the purple-blue bulging area outside the cerebral pedicle. 4 Select the hematoma closest to the cerebral surface, that is, cut 4 to 6 mm at the most bulging, enter the hematoma cavity, aspirate the hematoma with aspirator, and rinse with isotonic saline. If the bleeding has stopped, you can no longer explore the hematoma wall to find the bleeding, to prevent the brain stem damage. 5 suture layer by layer, close the skull. 2. Cerebellar pons Used to clear the hematoma in the pons on one side. The sequence of surgery was: 1 row of suboccipital midline incision or posterior mastoid vertical incision. 2 The lower part of the pillow is enlarged to form a circular bone window of 4 to 5 cm in diameter. 3 flaps of the dura mater, retract the cerebellar hemisphere, if necessary, cut off the lateral 1/3 to increase exposure. Look at the facial nerve and auditory nerve and the trigeminal nerve into and out of the pons, and the lateral side of the pons, in the shallowest part of the hematoma or bulging outside the pons, longitudinally cut the pons. The operation to remove the hematoma is the same as the approach. 3. Fourth ventricle approach It is used to remove the medullary medulla hematoma near the bottom of the fourth ventricle, that is, the diamond-shaped fossa. The surgical methods are: 1 midline incision in the lower part of the occipital, scalp scalpel resection, the posterior margin of the occipital foramen and the posterior arch of the atlas are the same as the decompression of the posterior fossa. 2 "Y" shape to cut the dura mater. 3 The cerebellar tonsils were separated to the sides, and the lower half of the diamond-shaped nest was seen. The cerebellum was covered with a saline cotton sheet, and the lower jaw was cut 1 to 1.5 cm to expand the exposure. Check the ridges of the diamond-shaped fossa or the discoloration of the purple-blue color, preferably under the microscope, to enter the hematoma cavity. The method of removing the hematoma is the same as the approach of the lower jaw. complication 1. Respiratory and circulatory failure. It must be handled in time. 2. Difficulty swallowing. Nasal feeding should be done early to ensure adequate nutrition. 3. Difficulty breathing. When the discharge is difficult, the tracheotomy is performed. 4. Protracted sexual dysfunction. Use neurotrophic drugs to strengthen care.