Strategies and techniques of craniotomy for hypertensive putamen hemorrhage

Objective To retrospectively analyze the treatment effect of craniotomy on 120 cases of hypertension putamen hemorrhage by microsurgical techniques with small bone window,and investigate the strategies and techniques of craniotomy.Methods One hundred and twenty cases of hypertensive putamen hemorrhage had craniotomy,at a distance of 8 cm from zygomatic process of the frontal bone,around the surface the lateral fissure lines,with frontotemporal curved incision,made a bone window of 2-4 cm in diameter,longitudinal incision with the diameter 2-3 cm were made on the no vessels edge of the cortex in the lower part of the central gyrus and top part of lateral fissure.The brain tissue was separated with 1 cm wide plates and the hematoma was removed,and then the residual hematoma was removed under the operating microscope,and the vessels were coagulated.Controlled the blood pressure and maintain drainage tube patency postoperatively,CT scan were made to evaluate surgical results after 12 hours.Results Hematomas were removed in more than 80％ of the 98 cases (82.0％),totally removed in 65 cases (54.1％),rebleeding in 5 cases (4.1％).Patients with hematoma totally removed showed no significant cerebral edema,brain structure restored earlier and better.Followed up for 9 months to 4 years,GOS score:good recovery in 25 cases (20.8％),mild disability in 20 cases (16.6％),moderate disability in 37 cases(12.5％),severe disability in 23 cases(19.2％),15 cases (12.5％) died.Conclusions The method to treat the hypertension putamen hemorrhage by microsurgical techniques with small bone window is feasible,with little trauma and better treatment effect. Key words: Hypertensive intracerebral hemorrhage ;  Microsurgery ;  Craniotomy