Endoscopic evacuation of intracranial hematoma

The main advantage of neuroendoscopy in the treatment of intracerebral hematoma is the operation under small trauma and direct vision. The surgeon can not only use this method to avoid large-area brain tissue exposure and damage caused by craniotomy, but also can use the good illumination of the endoscope and expand the visual field to clearly distinguish the boundary between the hematoma and the brain tissue, and find active bleeding points in time. In turn, it creates conditions for effective hemostasis during surgery and accurate catheterization after surgery. Therefore, the removal of intracranial hematoma under endoscopic direct vision is superior to craniotomy and stereotactic hematoma emptying. Nishihara et al (2000) used clear endoscopy to remove intracerebral hematoma. Intraoperative not only can see the distribution of hematoma, but also can clearly see the boundary between brain tissue and clear hematoma 86%~100%. It is worthy of reference. Treatment of diseases: acute intracerebral hematoma and subacute intracerebral hematoma Indication 1. Hematoma in the brain parenchyma (including basal ganglia hematoma, subcortical hematoma, cerebellar hematoma, etc.). 2. Intraventricular hematoma. 3. During the medical treatment process, the condition continues to worsen, and the hematoma should be removed in the early stage (within 7 hours after the onset). Contraindications 1. Late cerebral palsy, sudden death. 2. Systemic and important organ failure. 3. The amount of bleeding is large, the disease progresses rapidly, and the cerebral palsy is late. Preoperative preparation 1. There must be a correct positioning diagnosis before surgery. In recent years, due to advances in imaging inspection technology, clinical applications such as CT, MRI, and DSA have become increasingly widespread. The relationship between the location of the lesion and the surrounding structure should be analyzed before surgery in order to select the appropriate surgical approach, to obtain the best exposure, avoid the important structure of the skull as much as possible, increase the safety of the operation and strive for good Effect. 2. Apply dehydration drugs and strive for more surgery time. 3. Prepare the endoscope supporting equipment. Surgical procedure 1. scalp incision and skull drilling According to CT or MRI images, close to the hematoma and no important functional parts were selected, and the epidermis was cut and the skull was drilled. 2. Cut the dura mater After the skull was drilled to a diameter of 1 cm, the "ten" was used to cut the dura mater. 3. Clear the hematoma A hard endoscope with a diameter of 6 to 8 mm is introduced into the center of the hematoma in the brain, and the hematoma is pumped through the endoscopic working channel and electrocoagulated to stop bleeding. Generally, 70% to 80% of the hematoma is removed to achieve better decompression. For chronic subdural hematoma, endoscopy can open the separation, which is conducive to adequate drainage of the hematoma. 4. Guan skull After most of the hematoma was removed, it was confirmed that there was no active bleeding, the endoscope was taken out, and the residual cavity was built into the silicone drainage tube. Stitch the scalp. complication The earliest and most serious complication after surgery is intracranial hemorrhage. A common cause is that hemostasis is not complete during surgery. Patients with concurrent intracranial hemorrhage, or delayed waking after surgery, or apathy, lethargy, headache, vomiting, seizures or re-coma after waking. Therefore, there is no special reason after surgery for a long time, not awake or consciousness is gradually worsened, and signs of increased intracranial pressure such as slow pulse, elevated blood pressure, or new neurological symptoms should be paid attention to, should be highly alert to the skull The possibility of internal bleeding. CT examination should be performed in time when conditions are met, and the hematoma should be removed immediately after diagnosis. The earlier the surgery, the better the consequences. If endoscopic surgery can not stop bleeding, craniotomy is required to stop bleeding.

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