Bone flap craniotomy: craniotomy although slightly larger on the scalp skull trauma, but can remove the hematoma, direct reliable hemostasis
Bone flap craniotomy: craniotomy although slightly larger on the scalp skull trauma, but can remove the hematoma, direct reliable hemostasis, rapid decompression, can also according to the patient's condition and intraoperative intracranial pressure changes whether decompressive craniectomy, is more commonly used and classic surgical approach. In general, the temporal or temporal flap of the lesion was performed by the middle temporal gyrus or lateral fissure approach. The temporal gyrus approach without vascular or less vascular brain area with needle puncture, hematoma cavity to obsolete blood, confirmed after the middle temporal gyrus or insular cortex incision about 0.5~1.0cm, separation into hematoma cavity with brain spatula; transsyivian approach, as much as possible to open the lateral fissure spider the omentum, the full release of cerebrospinal fluid, gentle retraction of the frontal or temporal lobe, can enter into the hematoma cavity. According to the time of bleeding and hematoma hardness, small to medium suction gently aspirating hematoma, individual hematoma is tough, the available ultrasonic aspiration or tumor forceps clip hematoma. Completely remove the hematoma cavity hematoma after examination, if the activity of arterial hemorrhage, available accurate hemostasia with weak coagulation, hemostasis material and brain cotton to stop bleeding blood infiltration, hematoma removal and determine all or substantially decrease intracranial pressure after satisfactory reduction of bone flap, layer closing skull, the end of operation. If the swelling of the brain tissue is obvious and the intracranial pressure is not satisfied, the decompressive craniectomy is feasible.
The small bone window craniotomy, small bone window craniotomy on scalp skull injury, surgical procedure is relatively simple, can quickly remove the hematoma, bleeding was satisfactory under direct vision. In patients with temporal bone upward parallel to the lateral fissure projection of skin incision about 4~5cm long, 1~2 in temporal bone drilling, milling cutter diameter of about 3cm bone flap, dural incision and "ten". It is also possible to use the middle temporal approach or lateral fissure approach. To determine the location of hematoma after the incision of the cerebral cortex, incision length of about 1cm, with a small brain pressure plate gradually separated into deep into the hematoma cavity, gently suction hematoma. After hemostasis, and confirmed that the brain pressure is not high, the brain beat good, suture dura mater, fixed skull bone flap, suture the scalp layer by layer.
Endoscopic evacuation of hematoma: removal of hematoma by rigid lens and stereotactic technique. In CT or ultrasound-guided puncture hematoma cavity, without vascular injury, brain tissue around and do not cause new bleeding as far as possible under the premise of intracerebral hematoma, but not force thoroughly, so as not to cause new bleeding, which reached the purpose can effectively reduce intracranial pressure.
The stereotactic hematoma aspiration: according to the location of CT hematoma, using stereotactic positioning or positioning, to avoid important blood vessels and functional areas, choose local anesthesia, small straight incision (2cm) scalp incision, incision of dura mater after drilling, under the direct transport puncture needle or common suction apparatus such as puncture hematoma for the first time with intracranial hematoma, aspirating hematoma volume restrictions should be for the purpose of decompression, hematoma cavity drainage channels or hard indwelling drainage tube drainage 3~5d.