Endoscopic assisted by the side ventricle kertenteric surgery to treat heavy ventricle hypocephalus hemorrhage

The neurosurgery of Xiangcheng People's Hospital in Suzhou City, May 2016-May 2018, under endoscopic assistance, surgical treatment of 12 patients with heavy ventricle type hypocephaly is treated with endoscopic ventricular kertology1Objects and methods1.1 Clinical data
9 cases of men and 3 cases of women; age 52-79 years old, average age 63.5 years old; 0.5 to 16.0h from the onset of illness to the emergency department of the hospitalGCS score: 9 to 13 points 2 cases, 7 to 8 points 8 cases, 4 to 6 points 2 casesClinical manifestations: pupils ranged from 3 cases, intracranial hemorrhage to the lateral limb muscle strength 0 to IIIPreoperative CT ct hypothalamus bleeding and breaking into the ventricle, the amount of hematoma in the brain is all 15 ml; secondary ventricular hemorrhage and cast, third ventricle enlargement, central brain water pipe and fourth ventricle blood accumulation, Graeb score of 6 points; Siemens MMWP workstation accurately measured the preoperative intracranial hematoma (97.5 x 6.7 ml, third, fourth ventricle accumulation of blood (25.4)1.2 surgical methodpatients general anaesthetic, take hypothalamus bleeding with the side of the intra-circular arc incision, milling the diameter of 2.5 cm bone flaps, prefrontal cortical fistula along the ventricle corner piercing direction 4 to 5 cm into the side of the ventricle, into the endoscope fixed, using Storz HD hard observation mirror, sucking out the same side of the brain chamber Hematoma in the thalamus, and accurately stop the bleeding, and then alternately use 0 and 30 degrees endoscopy to remove the clotting block of the clogging hole between the chamber, remove the blood clots in the side of the brain chamber, the endoscope looks directly down the 10 silicone tube in the third brain room, repeatedly use physiological saline fully scrubbing, as far as possible rinse out of the third chamber and the middle brain pipe, the blood build-up, the placement of the brain drain tube, bone reclining1.3 postoperative treatmentaccording to the condition or tracheotomy, in the first day after surgery, (4 to 1 days), (7 to 1 days) to review the head CT, assess intracranial hemorrhage absorption, 3 to 5d after the review of the head CT did not see non-traffic hydrocephalus signs, that is, remove the ventricular drainage tube, by anti-infection, hyperbaric oxygen tank and rehabilitation training and other comprehensive treatment, after 4 weeks Idgand2Results (Figure 1)12 patients within 24h after surgery, the first review CT: through the siemens MMWP workstation accurate measurement, the hematoma in the thalamus was cleared 9 cases, the majority of the removal (residual more than 3 ml) 3 cases; ml, hematoma removal rate of 70.9% to 85.8%, an average of 78.9% to 4.73%, the first day after surgery, the volume of blood accumulation in the third and fourth ventricles was (17.8 x 3.8 ml), a decrease of 30.2% to 37.5% compared to preoperativeAfter surgery, the improvement rate of 24h consciousness was 58.3% (7/12), and the improvement rate of consciousness within 1 week was 83.3% (10/12) After surgery, patients developed lung infection, electrolyte disorder and gastrointestinal bleeding were 11 cases, 11 cases and 1 case, respectively; All cases followed 3 to 6 months, GOS score 4 to 5 points 6 cases, 2 to 3 points 5 cases, 1 point (death) 1 case Figure 1 endoscopicly assisted by the side ventricle kertenteria surgical treatment of right-hand heavy ventricle type hypocephaly hemorrhage 1A preoperative CT shows right thalamus hemorrhage breaks into the ventricle and casts; 24h after 1B surgery reviews head CT with intracranial hematoma removal satisfaction; DTI examination under 1C endoscopy after entering the frontal ventricle kerb into the road; 1C endoscopic prompt hematoma surgery side cone conduction beam integrity; 1DD Temporal fistula surgery patients DTI show surgery side cone transmission beam interruption destruction 3 Discussion heavy ventricular hypocephalus haemorrhage leads to ventricular cast, causing acute expansion of the ventricle, blocking the cerebrospinal fluid circulation, the formation of non-traffic hydrocephalus, and even the appearance of cerebral palsy, the fatality rate is higher Early removal of hematoma in the thalamus and chamber of the brain, maximum retention of residual thalamus function, restoration of cerebrospinal fluid circulation, relief of cranial hypertension, is considered to be the early treatment target of heavy ventricular hypocephaly hemorrhage, which is important to improve the survival rate and quality of life of patients hypothalamus hemorrhage because of its special site, traditional open-cranial surgery, whether by side-cracking -island leaf into the road, external cracking and horn back into the road, triangular area into the road or temporal lobe fistula surgery, the surgical path will be different degrees of damage to the internal sac and other important areas of the nerve conduction beam, aggravating the patient's postoperative nerve dysfunction; Neuroendoscopy has developed rapidly in minimally invasive neurosurgery in recent years and is widely used in brain haemorrhage surgery the author's department under endoscopic assistance by the side ventricle kertenteria surgery treatment of heavy ventricle type hypocephalic hemorrhage patients, the first phase of surgery at the same time to remove hematoma in the thalamus and brain chamber, the clinical effect is obvious Compared to other surgical methods, there are the following advantages: (1) high hematoma removal rate Adjust the endoscopic angle, easily clear the same side and side of the brain room blood clots, look directly under the third ventricle built-in tube flushing suction, can clear the third ventricle and central brain water pipe hematoma, and even the fourth brain room hematoma, and through the side of the ventricle wall chole hemorrhage burst the first stage of the mouth At the same time to remove hematoma in the thalamus, so that the hematoma removal rate of the hypothalamus and the chamber of the brain is maximized, ventricle expansion can be restored in a short period of time, early lifting of the pressure on the cloty brain and the brain stem important nuclear group, so that patients in a shorter period of time after surgery to improve the consciousness disorder, and the length of preoperative consciousness disorder and the good ness of the prognosis inverseproportion (2) Surgery has little trauma The path through the side ventricle, inter-chamber holes and other physiological gaps to operate, the damage to brain tissue is small, the brain outdoor side wall thalamus brain hemorrhage naturally breaks the vents from the inside into the thalamus, do not go through the inner sac, as far as possible to avoid the cortical spinal cord beam and other important nerve conduction beams, always operate in the hematoma cavity, reduce the process of removal of hematoma on the secondary damage to thalamus tissue (3) stop the bleeding exactly Give full play to the close-up amplification effect of the neural endoscope hand-held microscope, as well as the angle mirror multi-view and angle observation function, to provide more clear surgical operation, accurate lying, reduce blind operation (4) There are fewer complications after surgery The shorter the duration of postoperative consciousness disorder, the lower the probability of complications And the operation to remove a large number of blood clots in the brain room, the flow time outside the brain is significantly shortened, no more use of urinary kinase, reduce the chance of intracranial infection, no case of intracranial infection in this group Remove hematoma from the third ventricle and mid-brain water pipes, restore the cerebrospinal fluid circulation in the ventricle system early, and reduce the incidence of traffic hydrocephalus Heavy ventricle type hypothalamus hemorrhage prognosis is poor, endoscopic lying under the help of the lateral ventricle into the road incision easy to locate, hematoma removal efficiency is high, side injury is small, hemorrhage is accurate, complications are few, can be further promoted and applied