The method of removing non-traumatic intracerebral haematomas origin

 

The invention relates to medicine, namely to neurosurgery. Spend encephalocele size of 2.0 cm and penetrate into cavity hematoma. Remove the liquid part of blood and centrally located convolution, then flow parietal blood clots. Then fastreroute the wall of the lateral ventricle length 7-9 mm In the bed of the hematoma stack drainage, which for two or three days current cerebrospinal fluid lyse and completely washed out left parietal located convolution blood. Encephalocele carried out in a "silent" area of the brain. In the postoperative period, carry out the removal of 250-300 ml of CSF per day for normalization of intracranial pressure, rehabilitation of spinal fluid. The method allows to reduce the invasiveness of the surgery and postoperative complications. 2 C.p. f-crystals, 2 Il.

The invention relates to medicine, namely to neurosurgery, and can be used to improve the clinical results of surgical treatment of patients with intracerebral hematomas nontraumatic origin of the hemispheric localization.

A known method of surgical treatment of intracerebral haematomas hemispheric localization, which in revelation is Beken A. S., Ponomarev, C. A., Nikolaev, A. G., Sharifulin R. A. // the Tactics of surgical treatment of patients with hypertensive intracerebral hematomas / 1st Congress of neurosurgeons of Russia: abstracts. Dokl. - Yekaterinburg. - 1995. - S. 272-273).

A significant drawback of this method is that this method of removal of the hematoma is traumatic, often accompanied by blood loss, prolonged narcosis, that adversely affect the further course of the disease in elderly patients, usually with accompanying pathology. The approach and removal of large and deep intracerebral haematomas in this method, always accompanied by a significant brain injury and leads to severe neurologic symptoms, as you have to dissect the brain over a large area in functionally important areas of the brain. In addition, straightforward visual review is not always possible to see and completely remove not all clots of blood from the hematoma cavity.

A known method of removal of intracerebral hematoma using endoscopic techniques through a small craniotomies access to inspect the cavity hematoma and delete its contents (Danchin A., / / the Application of endoscopic techniques to some the practical access. /Proceedings of the VI international. proc. The surgeon. gepatol. CIS / Actual problems of the surgeon. gepatol. - Kiev. - 1998. - S. 365-366).

The disadvantage of this method is that when you remove intracerebral haematomas access is often done through the parts of the brain that are important in functional terms (motor area of the cortex), which in the postoperative period, as a rule, leads to the deepening of focal neurological symptoms. Using this method does not guarantee a full removal of blood clots, especially parietal located, not visible on the background gemorragicheskii soaked brain tissue. This method does not assume and drainage of the hematoma cavity. But not deleted clots of blood in the hematoma cavity contribute to long-term maintenance of the volume of this cavity, which adversely affects the pathways of white matter of the brain and prevents regression of focal neurological symptoms.

Closest to the claimed is surgical access described Golovko A. M. and Rubidium N. With. (Comparative analysis of endoscopic removal of intracerebral haematomas in hemorrhagic stroke // proceedings of the VI international. the Symposium. Modern minimally invazivnogo brain cannula "blind" puncture and aspirinum the liquid part of the hematoma. Next, after dissection of the brain through the brain into the cavity hematoma was introduced strict diagnostic endoscope and surgical intervention was carried out by a vacuum suction device and to perform input poona the endoscope is immersed in the resulting cavity.

This method is quite traumatic: first, you need to first puncturevine cavity hematoma thick cannula that does not always work the first time. Secondly, the cavity is immersed diagnostic, and not handling the endoscope and remove the hematoma occurs instruments entered not inside and outside of the endoscope, which also leads to additional brain injury. In addition, the initial stage of operations to be performed "blindly", can cause damage to brain blood vessels, increased swelling of the brain and deepening of focal cerebral symptoms. According to the authors, this method does not provide good visualization of deep structures of the brain by spadine swollen brain tissue and parietal bundles of blood, so efficacy of removal of the hemispheric intracerebral hemorrhage is only 60-90%.

In addition, this method does not involve drainage of the hematoma cavity. The lack of long and lysis of the remaining blood clots and keeping the resulting cerebral cavity, which always affects the regression of focal symptoms and worsen clinical outcomes.

The objective of the proposed method is a radical removal of intracerebral hematomas with minimal trauma to the brain through the use of individualtree, opening the wall of the lateral ventricle, drainage of the hematoma cavity and laundering parietal bundles of blood current cerebrospinal fluid.

The solution of this problem allows to achieve a positive therapeutic effect is to save the patient's life, to shorten his stay in hospital and significantly improve postoperative outcomes of treatment in this group of patients.

The problem is solved due to the fact that are encephalocele size of 2.0 cm and penetrate into cavity hematoma, remove the liquid part of blood and centrally located convolution, then flow parietal blood clots, then fenesteride wall of the lateral ventricle length 7-9 mm, in the bed of the hematoma stack drainage, which for two or three days current cerebrospinal fluid lyse and completely washed out left parietal located convolution blood. Encephalocele carried out in a “dumb” Sanogo pressure, rehabilitation of spinal fluid.

The method is as follows.

On admission the patient with suspected intracerebral hematoma was conducted thorough clinical and tomographic examination and confirmation of diagnosis - surgery.

To do this, after the minimum trephination and dissection of the Dura mater in the least physiologically significant ("dumb") area of the brain was dissected area of the cortex in length 2,0 see With minimal retraction of the substance of the brain was pushed back his spatulas, fixed spring retractors, and penetrated into cavity hematoma. After removal of liquid blood and repeated washing was created sufficient space for the introduction of strict diagnostic endoscope formed in the cavity. Further removal of intracerebral hematoma was performed under individualtree the micro tools (vacuum aspirator, loop, conchata) coaxially with the direction of movement of the endoscope. Individualtree gives you the opportunity to thoroughly and consistently perform a visual inspection of the cavity and remove the centrally located convolution blood. Then the cavity hematoma again well washed by the blood and carried out with the help of an endoscope visualanalog only parietal located unfixed blood clots. Tightly fixed parietal convolution of blood was left because of the risk of re-bleeding.

At the last stage of the operation after careful hemostasis was pervariabilis wall of the lateral ventricle during 7-9 mm, so that the liquor was freely drained from the ventricle and laundered left parietal blood clots. Make sure the flow of cerebrospinal fluid in the cavity hematoma was injected silicone drainage tube with a diameter of 3-4 mm for 2-3 days. This surgery was over. The bone flap was laid in place on the wound superimposed layered seams.

In the postoperative period within 2-3 days after surgery through the drainage was performed dosed evacuation of the liquor. Excretion of 250-300 ml of CSF per day resulted in normalization of intracranial pressure, rehabilitation spinal fluid, full-laundering parietal spaced bundles of blood and restore normal levorotary. Drainage from the cavity of the ventricle was removed as reorganization of the liquor for 2-3 days.

Specific example

Patient K., 1966 R., and/b 7337 enrolled in the Department of neurosurgery goose KKB, Barnaul, diagnosed with Gipertonicheskaya intracerebral hematoma in the left parieto-temporal area.

From history revealed that within 7 years, suffering from hypertension. Found the house in an unconscious state. Delivered to the nerve branch KKB machine assistance. Pulse 84 per minute. Blood pressure 150/90 mm RT. senior Speech contact no, the pain does not respond. Spontaneous locomotor activity in the left extremities, right-sided hemiplegia.

For diagnostic purposes prozveden KG and brain MRI. Revealed extensive intracerebral hematoma size 843 cm, depth localization in the left temporo-parietal region, the density of 69% N. (Fig.1).

After 34 hours after disease surgery. Quick access to the hematoma was performed as follows. Under endotracheal anesthesia with controlled hypotension in posterior parietal region on the left was cut free bone flap with a diameter of 4 see On the border of the parietal and occipital lobes in functionally insignificant area of the brain cortex dissected during 2,0 see the substance of the brain divorced spatulas introduced into cavity hematoma, which is fixed by a spring retractors. From the hematoma cavity using a vacuum aspirator removed its liquid part by volume of 25 ml. Of the endoscope. Coaxially he entered the vacuum aspirator. Under video control vacuum aspirator removed centrally located convolution blood (V=50 ml). Then again repeatedly cavity hematoma washed with saline. Carefully conducted individualtree showed that the walls of the brain throughout the cavity imbibition blood leaving many small parietal spaced bundles of blood. Removed only parietal spaced convolutions, which are easily espirituales (V=5 ml). Tightly fixed clots due to the large probability of re-bleeding was not removed. Total remote hematoma was 80 ml After removal of the blood cavity hematoma "eyes" significantly diminished in volume, brain fuse and slightly well beat steadily. Formed in the cerebral cavity made a careful hemostasis.

At the last stage of the operation for 7-8 mm dissected posterior horn of the lateral ventricle. Make sure the flow of cerebrospinal fluid into cavity hematoma, the operation has been installing it silicone drain with a diameter of 3 mm Dura sutured tightly, the bone flap is laid in place, the soft tissue is sutured in layers.

Sotobyi right-sided hemiparesis. Through silicone catheter per day dosed separated to 300 ml of liquor. On the third day after full renovation of cerebrospinal fluid drainage was removed.

The patient was in the Department of 22 days, then was transferred to the neurological Department for further rehabilitation. Moved with the assistance, as it was kept pretty rough, but gradually regressing hemiparesis and phenomena partial motor aphasia.

On the control computer tomography, performed 3 weeks after the operation, data for no hematoma (Fig.2). Lateral ventricles were slightly increased in size, located along the mid-line. Left paraventriculary have atrophic cavity size 321 cm, filled with cerebrospinal fluid and soamsawali with lateral ventricle.

Later, 4 months after the operation are saved right moderate hemiparesis, minor phenomena of motor aphasia. Disorders of higher nervous activity no.

Thus, removal of intracerebral hematoma was performed microsurgical access via functionally insignificant ("dumb") parts of the brain through the use of endowed is olilo completely remove the blood from the hematoma cavity, not to deepen neurological symptoms and get a good clinical result.

Claims

1. The method of removing non-traumatic intracerebral haematomas origin by applying a craniotomy and use individuating, characterized in that conduct encephalocele size of 2.0 cm and penetrate into cavity hematoma, remove the liquid part of blood and centrally located convolution, then flow parietal blood clots, then fenesteride wall of the lateral ventricle length 7-9 mm, in the bed of the hematoma stack drainage, which for two or three days current cerebrospinal fluid lyse and completely washed out left parietal located convolution of blood.

2. The method according to p. 1, characterized in that encephalocele carried out in a "silent" area of the brain.

3. The method according to p. 1, characterized in that in the postoperative period, carry out the removal of 250-300 ml of CSF per day for normalization of intracranial pressure, rehabilitation of the cerebral spinal fluid.

 

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SUBSTANCE: method involves applying one or two parallel through draining tubes having lateral perforations. Flow lavage of the retroperitoneal space with antiseptic solutions is carried out via the perforations at room temperature and cooled solutions are administered concurrently with vacuum suction. Omental bursa is concurrently drained using the two parallel through draining tubes. Flow lavage of the omental bursa is carried out using these tubes.

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5 cl, 1 dwg

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