Hypertensive intracerebral hemorrhage surgery

Because CT is widely used in clinical practice, the diagnosis of hypertensive cerebral hemorrhage has become rapid and accurate. With the development of microsurgery and stereotactic surgery, the accuracy of surgery has improved, and the trauma to brain tissue has been greatly reduced. The surgical indications for hypertensive cerebral hemorrhage continue to widen. It is generally believed that the hematoma is formed within 6 hours after the onset of the disease, and the edema reaches a peak at 8 to 24 hours after the hemorrhage. Before the hematoma is removed, a better functional recovery may be obtained. Early surgery can not only remove the hematoma in time, solve the intracranial hypertension, but also reduce the damage of blood decomposition products to brain tissue, which is of great significance for reducing the mortality and morbidity rate. Treatment of diseases: hypertension, cerebral hemorrhage Indication Surgical indications: There are no uniform standards for surgical indications for surgical treatment of hypertensive intracerebral hemorrhage. It is generally believed that the patient's age is not particularly large, and important organs function well. There are no serious complications such as deep coma, gastrointestinal bleeding, cortical rigidity, double pupil dilation and central hyperthermia, and one of the following conditions: 1 The amount of bleeding is above 20ml. 2 hematoma in the thalamus or basal ganglia. 3 If the cerebral ventricle breaks into the cerebral ventricle, the cerebral ventricle should be drained as soon as possible. At the same time, the waist should be worn once/d, and the cerebrospinal fluid should be 10-20 ml each time until the condition is stable. The drainage tube is kept for about 1 week under strict aseptic operation. 4 hematoma involving the brain stem and elderly or cerebral palsy are not suitable for surgery. 5 preoperative high blood pressure can lower blood pressure first. 6 vascular malformations or aneurysm rupture should be cautious. 7 cerebellar hemisphere bleeding volume is about 20ml. 8 The conservative treatment of internal medicine did not improve, the condition gradually worsened, or there was a cerebral palsy. Contraindications The choice of timing of surgery: In the past, people think that patients with cerebral hemorrhage are critically ill at early stage, the risk of surgery is high, and there is a risk of rebleeding. Surgery should be performed after 24 hours. In recent years, studies have shown that hypertensive cerebral hemorrhage usually forms hematoma in half an hour of hemorrhage. The edema around the hematoma has not formed within 3 hours. The bleeding stops 6 to 7 hours and there is edema around the hematoma. The brain tissue necrosis close to the hematoma, irreversible damage, 12h Moderate edema, severe edema at 24h, with the deepening of the research, most scholars advocate early or super early surgery, that is, within 6 to 8 hours after the onset of surgery can rush before the edema around the brain tissue of the hematoma, which can alleviate the hematoma The compression of brain tissue can prevent the occurrence of cerebral edema, break the vicious circle caused by a series of secondary changes such as blood cell decomposition and brain tissue edema after hemorrhage, and improve the survival rate and quality of life. Generally, surgery within 3 days after bleeding is appropriate. Whether or not puncture is used for more than 20 days after bleeding should be determined on a case-by-case basis. Preoperative preparation In addition to routine craniotomy preparation and preparation for blood, it is necessary to conduct necessary examinations around hypertension complications, such as electrocardiogram and renal function tests. Surgical procedure Common methods for removing hematoma surgery include: 1 neuroendoscopy; 2 minimally invasive surgery for hypertensive cerebral hemorrhage; 3 craniotomy for bone flap or bone window; 4CT-guided stereotactic aspiration; 5 ventricular drainage, hematoma Lysis.