高血圧性脳内出。血の手術方法の検討:-外側型に関して-

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Recently, the operation for the hypertensive intracerebral hematoma has been done very frequently. There are many types of these operations, so it is very complicated for us. We have experienced 38 operations of several types for these two years. The precise diagnosis of the location and size of the hematoma is very important for the operation. The necessity of the internal carotid angiography by the catheter with the magnification and stereoscopic techniques should be stressed for the precise diagnosis. Recently, the Delta scanner (Computed Tomography) is also offering us more important informations. The location and size of the hematoma are correlated each other; although the center of the hematoma should be located at the mid- insula and underneath the sylvian fissure, it mainly grows postero-medially and may grow toward the temporal and frontal lobes according to the size of the hematoma in the series of the autopsy. So, the shortest and best route to get the hematoma should be the trans-sylvian approach with horizontal straight incision which was introduced by J. Suzuki. Our method is consisted of two steps; one is the CVD (Continuous Ventricular Drainage) prior to the main procedure, another is the trans-sylvian approach with temporal straight incision. The former should be used to control the ICP (Intracranial pressure) during the operation and to make dural opening, cutting and dissection of the arachnoid, getting protrusion of the hematoma very easily, and the postoperative ICP monitor should be used for the management. The latter is planned with the 5 cm length straight incision from the point 4 cm antero-superior to external auditory meatus, on the line which is drawn with the external auditory meatus and anterior one third between the nasion and inion. The incision is along to the direction of the temporal muscle, and the ipsilateral STA-MCA anastomosis can be postoperatively planned because the anterior branch of the STA may be preserved.
The Japanese Society on Surgery for Cerebral Strokeの論文

高血圧性脳内出。血の手術方法の検討:-外側型に関して-

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