subcortical hematoma evacuation

Subcortical hematoma or cerebral hematoma accounts for about 15% of hypertensive intracerebral hemorrhage, and is more common in frontal lobe, temporal lobe, and parietal lobe. Attention should be paid to the differentiation of intracerebral hematoma caused by arteriovenous malformation or other causes. The CT scan can determine its location and size. Such as hematoma <30ml, clinical symptoms are stable, feasible conservative treatment observation, many patients can absorb self-healing. However, if the symptoms are aggravated during the observation, or the amount of hematoma is above 30 ml, the symptoms of the cranial hypertension are obvious, and surgery should be considered. This type of hematoma has a low mortality rate and early removal of the hematoma, which contributes to the recovery of brain function. Treatment of diseases: cerebral hemo Indication 1. The hematoma that occurs in each lobe is more than 30ml, with a midline shift, or severe edema around. 2. After medical treatment is ineffective, the condition continues to worsen, and the hematoma should be removed before the brain tissue is not subjected to irreversible damage. 2. Coma patients or semi-conscious patients should strive to clear the hematoma in the early stage. 3. After cerebral hemorrhage, when there is a manifestation of cerebellar incision, such as dilated pupils and disappeared photoreaction, surgery should be performed as soon as possible without surgical contraindications. 4. After the operation, the condition improved once, but after a certain period of time, the symptoms gradually increased. CT scan to confirm the formation of hematoma should be operated again. Contraindications 1. The disease develops rapidly, the condition is dying, the age is over 80 years old, and the patient is deeply comatose. 2. In the late stage of cerebral palsy, the pupils of both sides are dilated, the brain is strong, and the brain stem has severe damage. 3. Patients with severe coronary insufficiency or renal failure. Preoperative preparation 1. CT scan or MRI should be performed before surgery. 2. For patients with elevated blood pressure, blood pressure should be lowered appropriately. 3. When there is a dilated pupil on one side, you should immediately instill 20ml of mannitol 250ml, and quickly prepare for craniotomy to remove the hematoma, and strive to relieve the hematoma compression as soon as possible. Surgical procedure 1. Incision and bone flap craniotomy Generally, a horseshoe-shaped incision is made centering on the part of the brain that is bleeding, and the scalp and aponeurosis are turned downward, and the periosteum is pushed open at the predetermined drilling hole to prepare for drilling. Generally, 4 holes are drilled to form a bone flap, and the bone flap is turned down or laterally together with the periosteum. 2. Dural incision If the intracranial pressure is high, first cut a small mouth in the dura mater, puncture the hematoma after electrocoagulation to stop bleeding, extract some old blood and cut the dura mater in an arc, and the dura is turned to the sagittal sinus side. 3. Cortical incision hematoma clearance Select the avascular zone or cut the cortex 2~3cm centering on the puncture point. After bipolar electrocoagulation of the blood vessels on the surface of the brain, the cortex can be reached by separating the cortex with a narrow brain plate. The blood clot can be removed by using a suction device. After the hematoma was removed, the brain tissue collapsed and the pulsation recovered. The hematoma cavity was flushed with isotonic saline and the silicone tube was drained. If active bleeding is found, use bipolar coagulation to stop bleeding. When the suction device absorbs blood clots, it should prevent damage to surrounding brain tissue. 4. Guan skull After the hematoma is removed, the hematoma cavity is drained with a silicone tube. When the intracranial pressure is still high, the bone flap can be decompressed. For example, the brain tissue collapses, the pulsation is good, the dura mater can be sutured, the bone flap is restored, and the scalp is sutured layer by layer. complication 1. Rebleed after surgery. After CT confirmation, surgery is required again. 2. Gastrointestinal bleeding. Autonomic dysfunction caused by hemorrhage, stress ulcers, gastrointestinal bleeding, should be treated in time. 3. Postoperative hemiplegia or aphasia increased, and multiple lines were caused by pulling or damaging the exercise area and its conduction beam. Strengthen functional training after surgery.