Simple stereotactic puncture and drainage for supratentorial intracerebral hematoma

doi:10.19854/j.cnki.1008-2425.2023.06.0006

Abstract

Abstract: Objective This study aimedto introduce a simple stereotactic puncture method for intracerebral hematoma.Methods Sixty patients with intracerebral supratentorial hemorrhage were treated by hematoma puncture with a simple stereoscopic positioning method in the Neurosurgery Department of Zibo First Hospital between January 2019 and October 2021.Cranial CT,square,metric,marker,and other tools were used to mark the three-dimensional projection of the puncture target and its coronal,sagittal,and axial plane on the patient's body surface before surgery.The line between the surgical site and the body surface projection of the puncture target was drawn as the auxiliary line to determine the puncture direction,and the puncture depth was calculated according to the body surface measurement results to guide and complete the puncture.Results The range of puncture error was 0~29 mm,with an average of 8.4±7.1 mm.The duration of hematoma drainage was 0~10 days,with an average of 3.6±1.8 days.The frequency of urokinase injection ranged from 0 to 10 times,with an average of 4.0±2.2 times.Preoperative hematoma volume ranged from 12.0 to 135.3ml,averaging 49.2±24.9 ml.Postoperative residual hematoma volume ranged from 1.0 ml to 35.4ml,averaging 9.7±9.3 ml.The percentage of residual hematoma ranged from 2% to 69%,with an average of 20.9±16.8%.Preoperative GCS scores ranged from 3 to 15 points,averaging 9.3±3.3 points.Postoperative exacerbation occurred in 5 patients,and one patient died.The GCS scores of the surviving patients at discharge ranged from 4 to 15,with a mean of 12.3±2.9 and a mean improvement of 3.0±3.3.Conclusion The simple three-dimensional positioning puncture method is a simple and practical surgical method with high accuracy and good drainage effect,especially for midline lesions.It has unique advantages and is suitable for widespread promotion.

Key words: Intracerebral hemorrhage, Puncture, Stereotaxy, Surgery

摘要： 目的介绍一种脑内血肿简易立体定位穿刺引流方法。方法淄博市第一医院神经外科自2019年1月至2021年10月应用简易立体定位法幕上血肿穿刺引流治疗脑出血患者共60例,术前应用普通CT、角尺、分规、记号笔等工具在病人体表标记穿刺靶点的三维投影及所在的冠、矢、轴位平面,画出穿刺点与穿刺靶点体表投影之间的连线为穿刺辅助线来确定穿刺方向,根据体表测量结果计算穿刺深度,以此为指导并完成穿刺。结果本组患者的穿刺误差范围为0~29 mm,平均为8.4±7.1 mm。血肿腔引流天数为0~10天,平均为3.6±1.8天。尿激酶注入次数为0~10次,平均为4.0±2.2次。术前血肿体积为12.0~135.3 ml,平均为49.2±24.9 ml。术后残留血肿体积为1.0~35.4 ml,平均为9.7±9.3 ml。残留血肿百分比为2%~69%,平均为20.9±16.8%。病人术前GCS评分为3~15分,平均为9.3±3.3分。术后5例病人加重,其中1例病人死亡。存活病人出院时GCS评分为4~15分,平均为12.3±2.9分,GCS评分平均改善为3.0±3.3分。结论本简易立体定位穿刺引流法是一种简单实用、准确性高、引流效果好的手术方法,尤其对于中线部位的病变有独特的优势,适合广泛推广。

关键词: 脑内血肿, 穿刺引流, 立体定位, 神经外科

CLC Number:

R743.34

Zhao Qinghai, PanPing, WangShuai, et al. Simple stereotactic puncture and drainage for supratentorial intracerebral hematoma[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2023, 36(6): 348-353.

赵青海, 潘平, 王帅, 孙冬雪, 周德宝. 幕上脑内血肿简易立体定位穿刺引流法[J]. 立体定向和功能性神经外科杂志, 2023, 36(6): 348-353.

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