Simple directional, conical intracerebral hematoma fragmentation and aspiration

Changfu craniotomy has a relatively high surgical burden on patients with hypertension, old age, and comorbidities. The mortality rate is also high (20% to 80%), and the surgical indications are stricter. Simple directional hematoma aspiration can reduce the burden on patients. In recent years, it has simplified and developed a stereotactic approach to treat hypertensive cerebral hemorrhage. Treatment of diseases: cerebral hemorrhage in the elderly Indication Because of the simplicity of this procedure, it is suitable for elderly patients with dysfunction and multiple comorbidities. It is especially suitable for deep hematoma such as thalamus. It can also be used for other types of hematoma. Compared with craniotomy, the surgical indications can be greatly expanded in terms of disease stage, hematoma volume, bleeding site and age. However, for patients with cerebral palsy or grade IV, it is advisable to remove the craniotomy with a decompressed bone. This method can also be tried for patients with V-grade patients, such as family members. If you want to change to IV or III, then further craniotomy is performed as appropriate. If there is no improvement, the operation will be abandoned. Contraindications 1. The blood coagulation mechanism has serious obstacles. 2. The patient is too old and should be filled with poor general condition. Preoperative preparation Shaving hair, no blood is necessary. Surgical procedure 1. Prepare a simple sieve plate positioning ruler, a protractor type orientation ruler, a trough hand cone and an intracranial hematoma crusher. 2. According to the number of cm of the anterior and posterior edge of the hematoma at each level on the CT OM line, transplant the hematoma pattern to the sieve plate of the positioning ruler, and then place the sieve plate frame on the frontal sac of the affected side of the skull. To align the OM line, the forehead is longitudinally aligned with the sagittal line, and then the hematoma pattern on the sieve plate can be transferred to the patient's scalp. The hematoma puncture point generally selects the vertical shortest distance from the center of the hematoma to the scalp, but if there is a blood vessel or an important brain center in the cerebral cortex, the puncture point and direction are modified by the protractor guide rule by: the ruler of the guide ruler Align the vertical shortest distance line from the center of the hematoma to the scalp and retract the same number of cm as the line. At this time, the center of the hematoma falls on the center of the arc of the guide ruler. At any point and direction on the ruler Can be stabbed in the center of the hematoma. 3. Puncture point scalp routine disinfection, local anesthesia, with a trough cone cone, if there is resistance to reduce or implement the sense of stop drilling. First, use a rounded blunt needle to test the depth of the CT in the hand cone groove. After confirming the penetration into the hematoma, insert it into the groove or introduce it into the same depth, then exit the die and install the spiral skein. Into the shredder tube, you can start the operation of smashing and removing blood clots. complication Results Through a series of targeted nursing measures for patients, all patients' postoperative complications disappeared and they were discharged from hospital.