Cerebellar hematoma removal

Cerebellar hemorrhage occurs in patients with hypertensive arteriosclerosis between the ages of 50 and 70 years, especially in patients with hypertension who are prone to cerebellar hemorrhage during anticoagulant therapy. In the past, cerebellar hemorrhage was mostly found at autopsy, and there were not many cases of clinical cure. After the onset of CT and MRI, the diagnosis of cerebellar hemorrhage is rapid and accurate, and the disease can be diagnosed early, which improves the cure rate and reduces the rate of death and disability. Small hematoma below 10ml is feasible for non-surgical treatment; more than 10ml of hematoma must be treated with surgery, because the space behind the cranial fossa is small, and it is the center of life. Once hemorrhage forms hematoma, it will quickly produce serious symptoms and signs, so it should be treated like The acute epidural hematoma takes a positive attitude, and the hematoma is cleared every second. Treatment of diseases: acute intracranial hematoma multiple intracranial hematoma Indication Cerebellar hematoma evacuation is applicable to: 1. The amount of hematoma is above 10ml, the symptoms of intracranial hypertension and cerebellum are obvious, or the condition is progressively worse. 2. The hematoma is close to the fourth ventricle. Although it is small, it is easy to break into the fourth ventricle or compress the four ventricles to deform, shift, and cause cerebrospinal fluid circulation disorder, resulting in acute intracranial pressure. Contraindications 1. The amount of hematoma is below 10ml, and the clinical symptoms are mild. 2. Bleeding breaks into the fourth ventricle, causing acute cerebrospinal fluid obstruction, deep coma, respiratory, circulatory failure, and late brain stem compression. 3. Old and frail with severe heart or lung function damage or failure. Preoperative preparation 1. The volume of the posterior cranial fossa is small. The important structures such as the brain stem, the posterior cranial nerve and the vertebral-basal artery cannot be damaged or excessively pulled. Therefore, the design of the incision is very important when the skull is opened. It must be accurately positioned before surgery. Surgical approach to meet the needs of surgical operations. 2. Under the occipital cranium, the neck should be reached. The skin preparation must include the full head, neck and shoulders. Surgical procedure Incision When the hematoma is small and the patient's general condition is still good without brainstem compression, a vertical incision can be made on the side of the hematoma. The hematoma is large. When the clinical symptoms are severe, the right incision in the lower part of the pillow is used. 2. Craniotomy Drill the scalp scales, use the rongeur to enlarge the bone window of the lower part of the pillow on one side or both sides. The posterior margin of the occipital foramen and the posterior arch of the atlas are bitten 1.5~2.0cm wide. 3. Dural incision When the dura is tight, the cerebrospinal fluid can be released by the lateral ventricle puncture, the dura mater is cut open by the star, and the cerebrospinal fluid is released by opening the cisterna. 4. Cerebellar incision to clear the hematoma Make a 1 cm long horizontal or vertical incision on the cerebellar surface adjacent to the hematoma. Before the incision, the blood vessels are treated by bipolar coagulation, and the hematoma can be tried without the brain needle, so as to prevent the needle stem from stabbing the brain stem. Separate the cerebellar incision 2 to 3 cm deep into the hematoma cavity, and use a suction device to clear the clot under direct vision or under a microscope. In case of small bleeding points, bipolar electrocoagulation is used to stop bleeding, and repeated flushing with isotonic saline. If there is no bleeding after removing the hematoma, it is not necessary to explore or find the bleeding blood vessels, and no drainage is needed. 5. Guan skull After the cerebellar hematoma is removed, the cerebellar hemisphere is often swollen. It is necessary to fully decompress the posterior fossa, and the dura mater is not sutured or the fascia is enlarged. After the muscles are completely hemostasis, the layers are tightly sutured. complication A pseudocyst in the posterior cranial fossa leads to aseptic meningitis. If local compression is not effective, surgery is required.