Stereotactic Attraction

Stereotactic aspiration surgery is a method of applying stereotactic orientation, drilling, and intracerebral puncture into a straw to absorb intracerebral hematoma. The method of aspiration to remove the hematoma is free of suction by an empty syringe (only part of the liquefaction of the hematoma) and Archimedes and CUSA for the removal of hematoma. Because of the lighter burden of this method, it is suitable for patients with hypertensive cerebral hemorrhage with old body failure and comorbidities. However, because it is a stereotactic surgery, special equipment and expertise such as stereotactic instruments and CUSA or Archimedes are required. Treatment of diseases: hypertensive cerebral hemorrhage Indication The indications for craniotomy can be relaxed to a certain extent. It is basically suitable for patients with hypertensive cerebral hemorrhage in all parts and stages except for grade I. It is especially suitable for deep basal ganglia and thalamic hematoma, and also for cerebellar hematoma. And even a report of brain stem hematoma. However, for large cortical hematoma, be careful to exclude bleeding caused by cerebral vascular malformation. Considering the amount of hematoma, generally 30ml or less medical conservative treatment, 30 ~ 100ml line of aspiration, more than 100ml craniotomy, 20ml of the thalamus, 10ml of the cerebellum, there are reports of improved functional prognosis, used near the internal capsule Small hematoma also achieved good results. Timing of surgery: Advocate 24 hours to 3 days is appropriate, especially after 24 hours of onset of CT reexamination of hematoma without progressive enlargement, because the suction surgery is not direct operation, can not stop bleeding; super early or active bleeding after surgery There is a danger of rebleeding. Surgical procedure Before drilling and suturing in the operating room, send it to the CT room, install the stereotactic instrument, and find the straight angle (azimuth and elevation) and the puncture distance between the two points according to the target of the hematoma center and the coordinates of the drilling site. Determine the angle of the attachment device at this angle, and find the coordinates of the two points according to the two levels through which the puncture needle passes and the intersection of the two points and the plane passing through the surgical target plane. If there is a gap between the coordinates of the intersection point and the hematoma target point Is the error. If the error is large, the puncture suction should be feasible after further correcting the angle of the puncture needle. The amount of aspiration is generally about 60% to 70% of the hematoma measurement amount (according to the Tada formula). The postoperative hematoma cavity is embedded in the catheter, and if necessary, supplemented with lead kinase chemical dissolution drainage treatment. The hematoma can usually be removed within 3 to 4 days. complication Intracranial hematoma.