Abstract:

Objective To investigate the clinical efficacy of minimally invasive suction combined with craniotomy and decompression without delay in the treatment of primary cerebral hemorrhage with cerebral hernia. Methods 100 patients of supratentorial primary cerebral hemorrhage with cerebral hernia from January 2018 to December 2020 were prospectively enrolled and randomly divided into observation group（n = 50）and control group（n = 50）. In the observation group，bedside minimally invasive suction and preoperative preparation were performed without delay for craniotomy hematoma removal and bone flap decompression. The control group received conventional craniotomy hematoma removal and bone flap decompression. The severity of cerebral hernia was distin⁃ guished by unilateral or bilateral dilated pupils at admission. The perioperative conditions and outcomes 6 months after operation of the two groups were compared. Results The good recovery/moderate disability rate and death rate in the observation group were significantly better than those in the control group（good recovery/moderate disability： 39.4% vs. 19.6%；death rate：8.3% vs. 26.1%），and the difference in prognosis between the two groups at 6 months after surgery was statistically significant（P < 0.05）. In patients with unilateral dilated pupil，the good recovery/ moderate disability rate in the observation group was significantly higher than that in the control group（59.4% vs. 31.0%），and the difference in prognosis between the two groups at 6 months after surgery was statistically significant （P < 0.05）. In patients with bilateral dilated pupils，there were no statistically differences in prognosis between the two groups at 6 months after surgery（P > 0.05）. In the observation group with unilateral dilated pupil，the good recovery/moderate disability rate of patients with significant contracted pupil after minimally invasive suction was significantly higher than that without significant contracted pupil（78.3% vs. 11.1%，P < 0.01）. In the observation group with bilateral dilated pupils，the persistent vegetative state/death rate of patients with significant contracted pupil after minimally invasive suction was lower than that without significant contracted pupil（36.4% vs. 100.0%，P < 0.05）. Conclusion The outcomes of patients with primary intracerebral hemorrhage accompanied by cerebral hernia treated with minimally invasive suction combined with craniotomy and decompression without delay are better than conventional craniotomy and decompression，and this approach can improve the good recovery/moderate disabil⁃ ity rate of patients with unilateral dilated pupil and reduce the death rate of patients with bilateral dilated pupils.

Key words:

intracerebral hemorrhage, cerebral hernia, minimally invasive puncture, hematoma removal