Minimally invasive intracranial hematoma removal

  Intracranial hemorrhage is common in acute cerebrovascular disease and has a high mortality and disability rate. Minimally invasive hematoma removal for intracranial.  hemorrhage is now receiving increasing attention in neurology. In patients with an aggressive onset and significant brain herniation, immediate bedside or CT examination bed surgery should be performed to decompress and release the herniation in a timely manner. Early stage (12 h~5 d): Although the efficacy of ultra-early surgery has been reported to be better than early or postponed surgery, we believe that the biggest advantage of minimally invasive technique treatment is easy operation and small trauma, and it is limited by the fact that the surgery is performed under non-direct vision hematoma and cannot effectively stop bleeding. The hematoma has already coagulated and the cerebral edema is not too heavy 12h-5 d after the onset of the disease, so surgery at this time is less likely to rebleed and has good results. The results of our clinical application also confirm this. Delayed ( > 5 d): At this time, brain tissue damage around the hematoma, cerebral edema is heavy, and there are many systemic complications, so the efficacy is poor.  Indications and methods: hypertensive supratentorial parenchymal hemorrhage with onset > 7 h and hematoma > 30 ml, perform drilled cranial hematoma laparotomy; cerebellar hemorrhage and subarachnoid hemorrhage with acute hydrocephalus, perform unilateral extraventricular drainage to resolve supratentorial hydrocephalus; primary or secondary ventricular hemorrhage, apply extraventricular drainage. Traditionally, the side containing less blood (healthy side) is chosen for extraventricular drainage, mostly because the blood on the healthy side is relatively small, non-coagulable and easy to drain; liquefaction can also be applied to drain the affected side ( intracerebroventricular injection of urokinase, 1 time/d, 2-6 u each time), because the primary lesion is in the brain parenchyma, plus the continuous secretion of CSF and drainage of the liquefied blood accumulation.  The results of clinical application confirm that older age, more complications, and severe impairment of consciousness are not absolute contraindications to minimally invasive surgery. Minimally invasive hematoma removal for intracranial hemorrhage is simple, less invasive, can remove the hemorrhage early, effectively prevent and stop the complications caused by hematoma and cerebral edema, significantly increase the survival rate, improve the quality of life of patients, and greatly reduce the death and disability rates of intracranial hemorrhage. This technique is carried out in the Department of Neurology and is managed by neurologists and nurses throughout the preoperative and postoperative periods, which is conducive to emergency care, systematic treatment and rehabilitation of patients.