thalamic hematoma evacuation

Thalamic hemorrhage is the heaviest cerebral hemorrhage, the highest mortality rate of bleeding: the outer capsule can be involved; the hypothalamus is involved downward; the cerebral pedicle is involved backwards; the lateral ventricle and the third ventricle can be penetrated upwards and inwards. . CT and MRI scans are the most accurate method for diagnosing thalamic hemorrhage. Thalamic hematoma can be divided into the following 3 types: Type I is a thalamic-restricted type of hemorrhage from the lateral or medial nucleus of the thalamus, forming a small localized hematoma in this part. Type II is divided into two types: intrathalamic cystic type, all of which are hematoma in the thalamus and extend to the inner capsule and the outer upper part, and some penetrate the lateral ventricle; hypothalamus and cerebral foot type, mainly to the medial, posterior hypothalamus and middle The brain is extended, and part of it is worn to the third ventricle. Type III is a large hematoma type inside and outside the brain, thalamic hemorrhage, rapid progress to the cerebral ventricle, with the third ventricle as the center, forming intraventricular and extrahepatic hematoma. If the thalamic hematoma is more than 10ml, it can be absorbed by conservative treatment. If the hematoma is more than 10ml and develops rapidly, more surgery is needed. Treating diseases: hypothalamic diseases Indication Thalamic hematoma clearance applies to: 1. The thalamic limited hematoma, first conservative treatment, hematoma enlargement of the disease progressively worse, surgery should be performed. 2. The cystic type in the thalamus, the extension of the thalamus hematoma to the internal capsule or the outer upper is an absolute indication for surgery. Contraindications 1. The thalamic limited bleeding is below 10ml, the patient's consciousness is clear and the signs are mild, no surgery is needed. 2. Thalamic hemorrhage, rapid progress, hematoma has been broken into the third ventricle, it is not suitable for surgery. 3. The thalamic hematoma spreads to the hypothalamus or brainstem, and the patient is deeply comatose, going to the brain for rigidity or in the late stage of the cerebral palsy. Preoperative preparation 1. There must be a correct positioning diagnosis before surgery. 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. Prepare the skin, wash your head with soap and water before surgery, and shave your hair. 3. Give phenobarbital 0.1g, atropine 0.4mg or scopolamine 0.3mg intramuscularly 1h before surgery. Surgical procedure 1. scalp incision and craniotomy Depending on whether the hematoma is located in the anterior or posterior part of the thalamus, the approach of the frontal cortex and the parietal cortex into the lateral ventricle is used. When the posterior ventricle triangle is approached, a horseshoe-shaped incision is made centering on the apical nodule, and the flap is turned to the temporal side, and the periosteum is pushed open at the predetermined drilling hole. Make a top 4-hole bone flap with the bone flap and the periosteum turned down. The dura mater was cut in an arc and the pedicle was turned to the sagittal sinus side. 2. Cortical incision to remove hematoma In the posterior part of the apex, which is equivalent to the avascular region of the apical gyrus, the cerebral ventricle is punctured, and a small amount of cerebrospinal fluid is released from the lateral ventricle triangle. Then, the avascular region is anteriorly incision and the cortex is cut 2 to 3 cm. The direction separates the cerebral cortex and its fiber bundle into the ventricle, cuts the ventricle wall to the posterior and triangular regions of the lateral ventricle, and expands the surgical field with the ventricular retractor, so that the choroid plexus of the lateral ventricle triangle can be clearly seen. Found to bulge above the thalamus. Cut into the hematoma cavity at the thinnest part of the hematoma, and gently suck out the blood clot with a suction device (Fig. 4.4.1.6-2B). Note that the brain tissue damage is not aggravated, and bipolar electrocoagulation is used to stop bleeding when there is active bleeding. The operation is preferably performed under a microscope. Because the hematoma is close to the midbrain and hypothalamus, it is impossible to forcibly absorb small blood clots attached to the wall of the hematoma when the blood is removed. After the hematoma is removed, the silicone tube is drained in the lateral ventricle. 3. Guan skull After the hematoma was removed, the drainage tube was drained from the lateral cerebral ventricle, the dural was sutured, the bone flap was repositioned, and the scalp was sutured layer by layer. complication 1. High fever. Apply physical cooling and hibernation drugs. 2. Gastrointestinal bleeding. The clinical manifestations are vomiting a large amount of brown stomach contents and blackening stools, and the treatment uses various hemostatic agents, antacids and gastrointestinal decompression. 3. Rebleed after surgery. CT review if necessary.

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