Craniotomy for hematoma removal

It is divided into two methods: forming craniotomy and decompression of the diaphragm and craniotomy. It is a routine craniotomy. Treatment of diseases: intracranial hemorrhage, multiple intracranial hematoma Indication 1. Classification of the disease: According to the preoperative consciousness state and main signs, it is divided into 5 levels. Grade I: The mind is basically clear or lethargic, non-surgical treatment can be used to continue observation; Grade II: Dementia or lethargy, pupils, etc., different degrees of aphasia and hemiplegia, can be treated non-surgical first, such as symptoms progression, deterioration of surgery; Grade III: shallow coma, pupils such as large or mild unequal, limb insufficiency or complete paralysis, surgical treatment; grade IV: moderate coma, affected pupil dilated, contralateral limb hemiplegia, emergency surgery, auxiliary subtraction Pressure; V-class: deep coma, sick side or bilateral pupil dilated, go to the brain tonic, sudden death, should give up surgery. 2. CT scan results (by bleeding site and hematoma volume): 1 core nucleus hemorrhage: is the main target of surgical treatment, according to the calculation formula of hematoma volume proposed by Tada (T = / 6 × L (long axis) × S ( Short axis) × Slice (layer thickness)], hematoma > 50ml for active surgery, 30 ~ 50ml for surgery, 30ml for non-surgical treatment; 2 thalamic hemorrhage: for non-surgical treatment, surgical selection should be very careful. The amount of bleeding is above 20ml, and the rupture into the ventricle forms an obstruction. If the disease progresses rapidly, the surgical treatment can be selected. 3 The cerebral lobe hemorrhage: more than 50ml, or the hematoma involved or oppressed the functional area, the operation is better. , often can resume work; 4 cerebellar hemorrhage: for the absolute indications of surgery, the amount of bleeding should be surgery about 10ml; 5 pons bleeding: non-surgical treatment; 6 hematoma broke into the ventricle and caused obstruction should be actively treated. 3. General condition of the patient: The age is below 60 years old, the blood pressure systolic pressure is below 26.7 kPa (200 mmHg), there is little or no comorbidity, and there are no serious diseases in important organs. It can be selected for surgery and should be flexibly mastered. However, seniors also have successful surgery. In addition to the above conditions, the diagnosis is unknown, the bleeding site of young patients is superficial, CT scan hematoma is mixed density, can not exclude cerebral vascular malformations, cerebral angiography should be performed before surgery, and the diagnosis should be performed before surgery. Timing of surgery: Anyone with surgical indications, the sooner the surgery is better, generally within 24 to 48 hours of surgery, try to fight for early surgery (within 7 hours after onset). Contraindications Undiagnosed, young patients with superficial bleeding, CT scan hematoma is mixed density, can not exclude cerebral vascular malformations, cerebral angiography should be performed before surgery, after diagnosis and surgery. 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 1. Craniotomy: According to CT or other examination methods, make a corresponding horseshoe-shaped incision, make a bone flap, or bite the skull. The former is fully exposed, the latter is fast, the burden is light, and external decompression is naturally formed after surgery. 2. Incision of the cortex, removal of hematoma: typical basal ganglia lateral hematoma surgery, mostly using the anterior or middle anterior approach. Generally, the hematoma cavity can be reached by deepening 5cm. There is also a splitting of the lateral fissure, and the entry of the island leaf into the hematoma, the cortical damage of this approach is light, but to avoid damage to the lateral fissure vessels. After clearing the hematoma, there are still active bleeding in the bean vein arteries. It is best to stop the bleeding under the operating microscope and only clip the bleeding branches to ensure that the trunk is not damaged. Deep in 5 ~ 7cm to the hematoma cavity are mostly basal ganglia hematoma. During the operation, the wall of the hematoma should not be damaged as much as possible, and a small amount of blood clot attached to the wall of the hematoma should not be removed. Especially in the deep medial hematoma, it is necessary to avoid blind electrocoagulation to stop bleeding. The hematoma that breaks into the ventricle should be removed, but the middle or the apical approach should be used. The cortex should be cut open, the intracerebral hematoma should be removed, and the residual hematoma in the brain should be removed through the perforation of the lateral ventricle wall. . 3. At the end of the operation, the blood pressure should be raised to the original level, and the hemostasis should be checked thoroughly. According to the intracranial pressure during the operation, it is decided whether to decompress the bone. 4. Craniotomy and suture: the same as conventional craniotomy (see commonly used craniotomy). complication Brain edema.