神经导航辅助改良内镜下经额长径清除基底节长条形血肿的疗效分析：单中心病例研究

Analysis of the therapeutic effect of neuro-navigation-assisted modified endoscopic transfrontal long diameter clearance of long strip-shaped hematoma in the basal ganglia region: a single-center retrospective study

摘要:

目的 探讨神经导航联合内镜技术改良微创经额长径清除基底节长条形血肿的安全性及有效性。方法 选取2020年1月－2023年1月该院收治的基底节长条形血肿患者30例，均采用神经内镜清除血肿，根据不同手术方法进行分组。其中，采用传统侧方额颞部皮层造瘘术式组（A组）10例，采用经侧裂术式组（B组）8例，采用神经导航辅助改良内镜下经额长径术式组（C组）12例。观察3组患者围手术期相关指标（手术时间、术中出血量、骨瓣直径、内镜摆动幅度、血肿清除率、术后第3和7天颅内压），以及预后情况［改良Rankin量表（mRS）评分］。结果 30例患者均在内镜下完成基底节长条形血肿清除手术，C组骨瓣直径明显短于A组和B组，内镜摆动角度明显小于A组和B组，血肿清除率明显高于A组和B组，术后7 d颅内压明显低于A组和B组，B组手术时间明显长于A组和C组，术中出血量明显多于A组和C组，差异均有统计学意义（P < 0.05）；3组患者术后6个月mRS评分比较，差异无统计学意义（P = 0.294）。结论 神经导航辅助改良内镜下经额长径清除基底节长条形血肿，可达到保护侧方重要白质纤维束的目的，且血肿清除率高，术后继发性脑损伤和水肿的程度较轻，颅内压控制好。值得临床推广应用。

Abstract:

Objective To explore the safety and efficacy of modified minimally invasive transfrontal long-diameter removal of long strip-shaped hematoma in the basal ganglia region by neuronavigation combined with endoscopic technology.Methods Thirty patients with long strip-shaped hematoma in the basal ganglia region from January 2020 to January 2023 were selected, and all hematoma was removed by neuroendoscopy. All of them underwent hematoma removal by neuroendoscopy and were grouped according to different surgical methods. Among them, 10 cases were treated with the traditional lateral frontotemporal cortical fistula procedure (group A), 8 cases were treated with the translateral fissure procedure (group B), and 12 cases were treated with the modified endoscopic transfrontal long diameter procedure assisted by neuronavigation (group C). Observe the perioperative related indicators (operation time, intraoperative blood loss, bone flap diameter, endoscopic swing angle, hematoma clearance rate, intracranial pressure on the 3rd and 7th days after operation) of the three groups of patients, as well as the prognosis [modified Rankin scale (mRS) score].Results All 30 patients underwent endoscopic resection of long linear hematoma in the basal ganglia region. The diameter of the bone flap in group C was significantly shorter than that in group A and group B, the angle of endoscopic swing was significantly smaller than that in group A and group B, the hematoma clearance rate was significantly higher than that in group A and group B, the intracranial pressure 7 days after the operation was significantly lower than that in group A and group B, and the operation time of group B was significantly longer than that of group A and group C, the intraoperative blood loss was significantly more than that in group A and group C, and the differences were statistically significant (P < 0.05). There was no statistically significant difference in the mRS score among the three groups of patients at 6 months after surgery (P = 0.294).Conclusion Neuronavigation-assisted modified endoscopic transfrontal long diameter clearance of long strip-shaped hematoma in the basal ganglia region can achieve the purpose of protecting the important lateral white matter fiber tracts, with a high hematoma clearance rate, mild postoperative secondary brain injury and edema, and good intracranial pressure control. It is worthy of clinical promotion and application.