intraventricular hematoma evacuation

About 55% of patients with hypertensive intracerebral hemorrhage occur in the nucleus of the nucleus, while the hemorrhage of the nucleus often breaks into the lateral ventricle from the fragile triangle of the caudate nucleus and the inner capsule. Therefore, hemorrhage in the lateral ventricle accounts for cerebral hemorrhage. above 50. The medial type of hemorrhage in the thalamus breaks into the third ventricle and accounts for only 10%. The subependymal hematoma formed by cerebral hemorrhage can break into the fourth ventricle. When the blood volume is broken into the ventricle, one or part of the ventricle can be filled, but when a large amount of blood enters the ventricle, a hematoma can be formed and the ventricle system is cast. As the blood enters the ventricular system, it affects the circulation of cerebrospinal fluid, causing obstructive hydrocephalus, causing an increase in acute intracranial pressure, causing the patient's symptoms to rapidly deteriorate and cerebral palsy to cause death. Explosive hypertensive cerebral hemorrhage seen clinically refers to this type of bleeding. In order to relieve the increase of acute intracranial pressure, it is necessary to remove the obstructive intraventricular hematoma as soon as possible, otherwise it will be caused by brain stem damage secondary to brain stem damage. The application of CT scan can make a correct diagnosis in the early stage of intraventricular hemorrhage, and actively adopt surgical treatment, which will greatly improve the prognosis of intraventricular hemorrhage. Some authors report that the mortality rate of surgical treatment of ventricular hemorrhage has fallen below 15%. Zhu Yi et al (1999) reported the use of ventricular drainage + urokinase in the treatment of hypertensive intraventricular hemorrhage in 64 cases, 7 deaths, the mortality rate was 10.9%. Zhang Yanping (2000) reported that surgical treatment of hypertensive cerebral hematoma broke into the ventricle in 75 cases, 10 deaths, and the mortality rate was 13.33%. Treatment of diseases: cerebral hemo Indication 1. CT scan confirmed that the ventricle is filled with blood and cast, causing a sharp increase in intracranial pressure. 2. Shell nucleus - pyramidal tract - cerebral cerebral hemorrhage, most of which have broken into one side of the ventricle. 3. Due to intraventricular hematoma, the patient presented with deep coma, high intracranial pressure, prodromal symptoms of cerebral palsy, or dilated pupils on one side, deepened consciousness disturbance, and weakened contralateral limbs or hemiplegia. 4. Obstructive hydrocephalus formed by intraventricular hematoma, no improvement by ventricular drainage or other conservative treatment. Contraindications 1. The patient is too old, accompanied by multiple organ dysfunction, surgery can not change the condition. 2. At the time of admission, he was in the late stage of cerebral palsy caused by cerebral hematoma, and there were signs of respiratory and circulatory failure. 3. Poor respiratory tract, high fever, severe pulmonary complications. Preoperative preparation 1. Patients with critical illness, poor respiratory tract, and severe hypoxia should be intubated or cut open to improve ventilation and brain, heart and lung function. 2. Rapid CT scan to determine intraventricular hematoma distribution, hematoma size and ventricular obstruction to determine the surgical approach. Surgical procedure Incision When most of the blood clots enter the anterior horn of the lateral ventricle, a forehead horseshoe-shaped incision is used. If most of the blood clots accumulate in the posterior part of the lateral ventricle, a posterior horseshoe-shaped incision is taken. 2. Craniotomy For the forehead or top bone flap craniotomy, generally drill 4 holes, the frontal bone flap turns to the front, and the top bone flap turns to the ankle. 3. Dural incision When the meningeal tension is very large, the ventricle puncture and drainage should be performed before the dural incision to reduce intracranial pressure (but the ventricle is generally difficult to release a large amount of liquid for the blood mold); it can also be rapidly intravenously instilled with 20% mannitol 250ml and Furosemide 20 ~ 40mg, most patients with intracranial pressure can be temporarily relieved. The dura mater is curved and turned to the sagittal sinus side. 4. Brain incision Generally, the cortex is cut 3 cm in front of the middle and back movement area. Before the incision, the cerebral needle can be used to puncture the anterior horn of the lateral ventricle, and a little clot or old blood can be taken out to determine the direction and depth of entering the lateral ventricle. Then use two brain pressure plates to separate the cortex about 3 to 4 cm along the direction of the puncture needle, and then enter the lateral ventricle. At this time, some black blood clots are often emerged from the incision, the scope of the incision is enlarged, and the bleeding point of the white matter on both sides of the electrocoagulation is used. After the peripheral brain tissue is protected by the cotton piece, the brain is automatically retracted by a ventricle or a snake-shaped automatic retractor. The incision was retracted, fully revealing the anterior horn of the lateral ventricle and intraventricular hematoma. If the hematoma is in the posterior region of the lateral ventricle, it can be cut 3cm in the cerebral ventricle of the cerebral ventricle. Before the incision, the cerebral needle is punctured, and the direction is aligned with the lateral ventricle triangle. After the black blood is collected by puncture, the needle is separated. The brain tissue can enter the lateral ventricle triangle area 3 to 4 cm deep, and the hematoma in the posterior part of the lateral ventricle is revealed and cleared. 5. Clear the hematoma The hematoma is placed in the cerebral ventricle and has little adhesion to the ventricle. The hematoma can be sucked out by the suction device. The blood clot can be clamped out by the tumor forceps. Do not increase the damage of the ventricular wall and surrounding structures. When most of the blood clots are removed, the isotonic saline is repeatedly washed, and blood clots entering the horn from the triangle can also be flushed out. Secondly, check the blood clots in the inter-chamber hole and the third ventricle, and gently suck it out; if the blood clot is too large to be sucked out, the one-side pryllar column can also be cut to enlarge the inter-chamber hole, so that it is easy to take out the third ventricle. Blood clot. The mound vein and choroid plexus of the posterior margin of the interventricular space are covered with cotton sheets to prevent hemorrhagic infarction caused by injury. If the third ventricle is enlarged due to abnormal blood clots, it can also be gently removed with a suction device or a tumor forceps, and washed with an isotonic saline containing antibiotics to completely remove the blood clots in the brain. Because intraventricular hematoma is broken into the ventricles by shell nucleus or thalamic hemorrhage, it is generally not necessary to find the original bleeding point. When flushing, a ventricular drainage tube is placed for postoperative drainage. If the brain tissue is swollen after removal of the hematoma, it is estimated that it is difficult to survive the edema after surgery, and the internal decompression surgery of the frontal anterior resection can be performed at the same time. 6. The dura mater is severely sutured, the bone flap is restored, and the scalp is sutured in two layers. complication 1. The main complication of intraventricular hematoma is obstructive hydrocephalus caused by obstruction of cerebrospinal fluid pathway after hemorrhage. Once it occurs, ventriculo-peritoneal shunt should be performed as soon as possible. 2. In the third ventricle, there may be central hyperthermia after surgery, so the body temperature should be strictly controlled and physical cooling treatment should be used.