神经内镜高血压脑出血微创手术的三维重建手术定位  

Three-dimensional reconstruction of CT imaging in endoscopic surgery of patients with hypertensive intracerebral hemorrhage

作　　者：陈祎招[1,2,3] 林波淼[4] 徐如祥[5] 聂永庚 赛力克[7] 王向宇[1,2,3] 张世忠[1,2,3] 柯以铨[1,2,3] 

机构地区：[1]南方医科大学珠江医院神经外科,广州510282 [2]广东神经外科研究所,,广州510282 [3]广东省脑功能修复与再生重点实验室,广州510282 [4]南方医科大学珠江医院放射科,广州510282 [5]北京军区总院神经外科,北京100700 [6]娄底市人民医院神经外科,娄底417000 [7]新疆医科大学第一附属医院神经外科,乌鲁木齐830011

出　　处：《中华神经医学杂志》2011年第3期280-283,共4页Chinese Journal of Neuromedicine

基　　金：广东省2010年度适宜卫生技术推广项目[粤卫（2010）152号]

摘　　要：目的 探索神经内镜高血压脑出血（HICH）做创手术术前精确可靠的手术定位方法。方法 南方医科大学珠江医院神经外科自2008年6月至2010年8月通过CT扫描及图像三维重建的方法定位脑内血肿、选择最佳内镜微创手术入路行神经内镜微创术治疗HICH患者18例，分析患者的临床资料和疗效。结果 根据CT三维重建结果，术者可以准确设计最佳内镜微创手术入路并实现颅骨钻孔部位的精确定位．减少手术前准备、麻醉及操作时间。本组患者平均手术时间仅1．5h左右，手术失血量仅30～40mL，血肿清除率约为89．2％，且血肿清除后脑组织松弛，无需行玄骨瓣减压。结论 HICH患者采用CT扫描、三维重建进行术前手术定位是一种快速、简便、可靠的神经内镜微创脑出血手术定位方法．Objective To develop a simple, fast and accurate preoperative planning method for endoscopic surgery of patients with hypertensive intracerebral hemorrhage （HICH）. Methods Eighteen patients with HICH, admitted to our hospital from June 2008 to August 2010, were performed endoscopic minimally invasive surgery; CT three-dimensional reconstruction was employed to locate the intracerebral hematoma and select the appropriate endoscopic approach before the endoscopic surgery. The clinical data and treatment efficacy were analyzed. Results According to the results of CT three-dimensional reconstruction, our neurosurgeons could design the best endoscopic approach; the three-dimensional relationship between intracerebral hematoma and scalp markers was shown directly and accurate positioning of the location of drilling was achieved; therefore, the time for preoperative preparation, anesthesia and operation was shortened. The mean operating time of these 18 patients was about 1.5 h; the volume of blood loss was only 30-40 mL; and the evacuation ratio was about 89.2%. After the elimination of hematoma, the brain tissues were flabby, so decompressive craniectomy was not needed. Conclusion CT three-dimensional reconstruction is a simple, fast and accurate preoperative planning method for endoscopic surgery of patients with HICH.

关 键 词：脑出血 高血压性 显微外科手术 神经内镜 

分 类 号：R651.1[医药卫生—外科学]