SU1498469A1 - Method of treatment of intracranial hematomes - Google Patents

Abstract

The invention relates to medicine, namely to neurosurgery. The method allows to reduce the invasiveness, which is achieved by a one-step operation in which the bone fragment is placed under the soft tissues and moved into its own bed after the drainage system has been removed.

Description

The invention relates to medicine, namely to neurosurgery.

The aim of the invention is to reduce the trauma of the operation, which is achieved by installing a bone fragment under soft tissues and moving it into its bed after removal of the drainage system.

The method is carried out as follows.

In the area of intervention, a soft tissue is cut through the linear incision, the part of the skull surface is exposed, the periosteum is preserved, then the bone disk is formed with a crown cutter. The disc during the operation is stored in an antiseptic solution. The dura mater is dissected by lambdavid incision, not to its mobilization along the edge of the opening. The dissection of the membrane is performed, one of its parts is elongated

Then, the intracranial lesion is removed, especially the hematoma or abscess. Upon completion of the main stage, a drainage system with a large bore diameter is inserted into the cavity formed, while the drainage is conducted through the edges of the elongated section of the solid membrane of the brain, taking in the remaining parts of the section.

Soft tissue detachment is made from the periosteum of the cranial vault in the area bordering the trephination opening in the direction of the elongated part of the solid brain sheath on the side opposite to the drainage system, a bone disk is placed under the soft tissues on the surface of the periosteum of the cranial vault with an offset from holes in the skull. The appearance of a gap between the edges of the disk and the orifice allows drainage through it without narrowing its lumen, which allows the use of transparent elastic wide tubes.

To ensure the metered and directed movement of the bone disk in its marginal part, a through-hole micro-hole is drilled, thread is passed through it, which leads through soft tissues to the outside through the wound edge opposite to the displacement of the bone disk. Before installing the bone disc, its edge-forming chamfers are removed, for example, with a scraper. After installing the bone disc, the wound is sealed with soft tissues, and the drainage system is usually brought directly through the wound. To objectify the timing of intensive drainage of the wound, an endofibroscope was inserted into the drainage system, carrying out a visual inspection of the condition of the drainable cavity through the end and transparent drainage walls. In the absence of pathological) "

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the accumulations of drainage are removed, after which the bone disk is moved with the overlap of the hole in the skull by pulling out the removed ends of the thread under the control of X-ray cranioscopy, then the thread is crossed and completely removed.

Example. Patient X., 53 years old, was admitted with suspicion of a volumetric process in the right hemisphere. Soon the state deteriorated sharply, dislocation symptoms joined. In case of emergency carotid angiography, a subdural hematoma of large sizes and dislocation of the median structures 1.5-2 cm was found. Emergency surgery: a curvilinear incision 7 cm long in the projection of the central sections of the right parietal bone revealed soft tissues, exposed skin with periosteum. A crown hole with a diameter of 25 mm is applied with a trelling hole with the formation of a bone disk. The hard shell of the brain was opened by a lambda-shaped incision with an elongated horizontal branch; the external hematoma membrane was discovered and excised within sight. The latter, in the form of liquid and dried blood, was removed with the help of the HoF-BO-1 endofiber microscope, combined with the drainage system, and the second cavity of the hematoma was detected and dissected.

Both cavities are successively freed from blood. The volume of hematoma is 120 ml, the gap between its walls exceeds 3 cm. A drainage system of silicone with a diameter of 8 mm is installed in the horizontal direction through the edges of the elongated part of the incision of the hard shell, drawn anteriorly. The hard shell is sutured with 3 seams: in the area of the shortened parts of the cut and at the junction of the shortened parts with the elongated. The bone disk is installed underneath the tissues on the periosteum of the parietal bone with its diameter displaced backwards from the hole 0.8 times its diameter and passing through the marginal microhole in the disk of the thread brought out to the outside, previously carried out under the muscle parallel to the drainage. Soft fabrics are sutured in layers. The operation lasted 70 minutes, the patient was transferred to the general ward, intensive wound drainage was established, which lasted 14 hours. After the control inspection of the cavity through the drainage using a sterile endofibroscope, the drainage system was removed, the bone disk was moved forward and inserted into the trefoin hole by pulling at the ends of the thread. Roentgenkont0 role showed the correct position of the disk in the hole. Thread removed. The patient was activated on the 4th day, and was discharged in a satisfactory condition.

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Claims (1)

Invention Formula A method of treating intracranial hematomas by imposing a trephination hole, followed by drainage of the hematoma cavity and closure of the surgical wound, 30 characterized in that, in order to reduce trauma, the bone fragment is placed under the soft tissues and moved into its bed after the drainage system has been removed.