Indications1.Basal ganglia hemorrhage >30ml, thalamic hemorrhage >15ml; hemorrhage broken into the ventricle, resulting in CSF circulatory disorders increased cranial pressure2.Lobar hemorrhage >30ml, with obvious intracranial pressure increase, resulting in obvious neurological or consciousness impairment3.Intraventricular hemorrhage, causing obstructive hydrocephalus or ventricular castsBenxi Railway Hospital Department of Internal Medicine Ren Zhongxiu
Estimation method of hematoma
Contraindications1, brain herniation and cause severe brain dysfunction2, bleeding due to cerebral aneurysm or arteriovenous malformation3, multiple brain hemorrhage4, brain stem hemorrhage5, obvious coagulation dysfunction or severe reduction of platelets6, combined with severe dysfunction of other organs
The timing of surgery is generally better to choose 6 to 24 hours after the onset of bleeding, and those who are at risk of brain herniation can be treated urgently.
Pre-operative preparation 1. explanation of the condition, informed consent 2. routine blood, coagulation, blood glucose, biochemical, cardiopulmonary function tests 3. observation of vital signs 4. reading CT films, estimation of bleeding volume
Precautions1.Avoid large vessels2.Gentle aspiration, aspirate no more than 1/33 of the total volume, continuous drainage no more than a week (the first time available urokinase 1 ~ 30,000 units injection, 2 ~ 4 hours after clamping open)4.Review CT 12 ~ 24 hours after surgery5.Avoid low cranial pressure: drainage tube height 20 ~ 25cm, after stabilization to 15cm6.Prevent intracranial infection