Microsurgical removal of nontraumatic intracerebral haematomas of brain hemispheres
Keywords:hemorrhagic stroke, nontraumatic intracerebral hematomas, surgical treatment, microsurgical removal
The purpose: optimization of transcortical approach for nontraumatic intracerebral hematomas (NICH) removing according to principles of minimally invasive neurosurgery.
Material and method. Microsurgical removal of NICH was performed in 62 patients aged from 25 to 73. Operations were performed according to developed unified methodology and include following steps: localized (using neuronavigation) circular craniotomy, puncture and aspiration of NICH liquid content, operative channel making around the cannula 15 mm diameter, microsurgical removal of hemorrhage, hemostasis (surgicell, trombine-contrical solution etc.), endoscopy (if needed), draining, surgery finishing.
Results. Postoperative lethality in first 30 days was 29% (18 patients died). According to Glasgow outcome scale in first 12 months favorable outcome was observed in 6 patients, satisfactory condition — in 31, poor — in 7.
Conclusions. Transcortical approach is effective at NICH of brain hemispheres 30 mm3 and more, located near cerebral cortex (the distance between them up to 25 mm).
Using advanced features: CT, neuronavigation, craniotome or crown saves, microscope and endoscope ect. — technique of transcortical approach for NICH removal consistent with the principles of minimally invasive neurosurgery.
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