I. Cerebral hemorrhage ( intracerebral hemorrhage ICH) is a spontaneous hemorrhagic cerebrovascular disease caused by the rupture of arteries, veins or capillaries in the brain parenchyma. It is a kind of cerebrovascular disease with high death and disability rate, which seriously threatens people’s health and life.
Second, the causes of cerebral hemorrhage
1.Hypertensive cerebral hemorrhage (80% of the cases)
2, non-hypertensive cerebral hemorrhage (accounting for 20%): congenital cerebrovascular abnormalities (cerebrovascular malformations, cerebral aneurysms) coagulation abnormalities tumors vascular disease vasculitis cerebrovascular amyloidosis brain base abnormal vascular network disease vasculitis drug-related
Third, treatment methods
Surgical treatment
Internal conservative treatment
It is generally believed that: bleeding >30ml in basal ganglia, bleeding >15ml in thalamus and bleeding >10ml in cerebellum should be treated surgically.
IV. Stereotactic minimally invasive puncture and drainage
(A) Superiority
According to the CT positioning, the positioning is accurate, and it can enter the center of the hematoma quickly and accurately.
The puncture needle is small (about 3mm in diameter), which causes little damage to the deep cortical nuclei and little secondary trauma to the brain tissue.
Tube placement and drainage avoids the damage to brain tissue and functional areas caused by craniotomy itself.
It reduces the amount of mannitol used in the treatment of cerebral edema.
There are no absolute contraindications, and it is not limited by age and functional status of important organs.
(II) Timing of surgery
Generally chosen within 3 days after 6 hours
Too early may lead to hematoma expansion
Too late, the secondary damage caused by cerebral edema has already appeared, which is unfavorable to the recovery of neurological dysfunction
Large amount of hemorrhage and signs of brain herniation formation should be operated immediately
(III) Cases
Before surgery
2 days after surgery
6 days after surgery (drainage tube was removed)