Clinical Effect Of Small Bone Flap Craniotomy In The Treatment Of Patients With Hypertensive Intracerebral Hemorrhage

Objective : Hypertensive Intracerebral Hemorrhage(HICH)is a potentially life-threatening cerebrovascular disease with high mortality.The aim of the present study was to assess the therapeutic effects of the small bone flap craniotomythrough lateral fissure-insula group andtemporal cortex surgicalgroup on patients with putamen hemorrhage and prognosis of recovery.Methods : 90 patients with putamen hemorrhage,whose hemorrhage last for 7-12 hours after onset(hematoma in the 40-50ml).Through small bone flap craniotomy,were randomly divided into control group(treated with the temporal cortex surgical approach)and observation group(treated with lateral fissure-insula approach).Comparethe two groups of patients with baseline indicators.The time of operation,blood loss,complications and the prognosis of recovery were compared.Moreover,the GFAPconcentration in the blood serumof these two groups were analysed and observed on the 1d,3d,7d,14 d after postoperation.Results:Comparison between the control group and the observation group.There's no statistical difference:sex,smoking,drinking,high salt diet,disturbance of consciousness and Classification of hypertension risk,age,blood loss,Preoperative time,GCS and pupil changebetween the two groups.Operating time was longer in the control group(3.2±1.7)h VS(2.8±0.8)h,(P<0.01),and blood losses were more important(126.3±42.8)ml VS(95.8±36.1)ml(P<0.01).More frequent complications,such us tracheotomy,pulmonary infection,digestive tract ulcer,hemianopsia and sensory aphasiawere found in the control group,(P<0.05).While there was no difference in the occurrence of other complications,including hypoproteinemia,urinary infection,electrolyte disturbance,epilepsy,contralateral hemiplegia and the GCS after a week,(P>0.05).Proportion of patients with good prognosis(the ADL I-III after one month,the GOS after three months)was larger in the observation group(P>0.05).In the first day after operation,no significant difference was found in the GFAP concentration in blood serum between these two groups(P>0.05),while the GFAP level of patients in the control group were higher than that of the observationgroup on the 3d,7d,14 d after operation(P<0.05).Conclusions:The putamen hemorrhage withoperation indicationvia a small window bone,the lateral fissure-insula approach is a betterin treatment than the temporal cortex surgical approach,with little damage,shorter operation time,reduce bleeding amount,improve the outcome and prognosis.Moreover,increased GFAP level may be a crucial index for the assessments of severity and prognosis,and diagnosis.