Acute Hypertensive Cerebral Hemmorrhage Surgery (NET-OCEAN)
Hypertensive Intracerebral Hemorrhage
About this trial
This is an interventional treatment trial for Hypertensive Intracerebral Hemorrhage focused on measuring neuroendoscope, trans-occipital approach, Acute Hypertensive Cerebral Hemmorrhage, Low-drainage Surgery
Eligibility Criteria
Inclusion Criteria:
- Diagnosed patients with spontaneous cerebral hemorrhage in the basal ganglia (in line with the diagnostic criteria of the American Adult Spontaneous Cerebral Hemorrhage Treatment Guidelines (2015)).
- Head CT showed; hematoma volume ≥ 30ml, intraventricular hemorrhage is not counted as hemorrhage volume.
- Time from onset to hospital admission ≤8h.
- The age of the patient is 15-75 years old.
- Glasgow Coma Score (GCS)> 5 points.
- The patient/family knows and signs the informed consent form.
- Have a clear history of hypertension in the past.
Exclusion Criteria:
- Bleeding caused by aneurysm, vascular malformation or tumor stroke.
- Combined with a history of head injury or trauma.
- There is more blood in the skull.
- Past mental disorders or neurological dysfunction.
- A history of procoagulant dysfunction or anticoagulant drugs.
- Patients with complications such as liver and kidney dysfunction.
- Those with poor compliance.
- Pregnant patients.
- With massive hemorrhage of the ventricle (the area of the hematoma in the CT side is larger than 1/2 of the transverse section), hemorrhage in the third and fourth ventricles with enlarged ventricles.
- With late-stage cerebral herniation (bilateral dilated pupils, central respiratory and circulatory failure).
- Severe cardiovascular and cerebrovascular diseases: such as myocardial infarction, cerebral infarction, coronary heart disease, myocarditis, malignant arrhythmia, etc.
- Participate in other clinical research 3 months before enrollment.
- The doctor in charge believes that the study plan cannot be followed.
- Those who are or plan to become pregnant or breastfeeding.
- Those who are known to be allergic to test drugs or related products.
Sites / Locations
- Department of Neurosurgery, Shanghai Changzheng Hospital
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Trans-frontal keyhole approach
Trans-occipital keyhole approach
After general anesthesia, the patient was placed in supine position with head frame fixed. A straight or arc incision was made in the hairline of the affected side. The incision was 3cm beside the midline. The length of the incision was about 4cm and the diameter of the bone window was about 2.5cm. According to the preoperative thin-layer CT scan, the dura mater and part of the cerebral cortex were cut, and the endoport and other hard channels were inserted. The incision reached 2 / 3 of the length of the hematoma along the direction parallel to the long axis of the hematoma, During the operation, mini aneurysms were clipped to close the responsible vessels, and hemostatic gauze was applied on the surface of the hematoma cavity. Silica gel external drainage tube was placed in the hematoma cavity. The external drainage tube led out the skin through the subcutaneous tunnel, and the dura was sutured.
After general anesthesia, the patient was placed in prone position with head frame fixed. According to the preoperative thin-layer CT scan, the long axis of hematoma was perpendicular to the ground, and the occipital puncture point was found along the extension line of the long axis of hematoma. Taking the puncture point as the center, a straight or arc incision parallel to the sagittal sinus was taken. The length of the incision was about 4cm, and the diameter of the bone window was about 2.5cm, Endoport and other hard channels were inserted to reach 2 / 3 of the long diameter of the hematoma along the direction parallel to the long axis of the hematoma. Under the neuroendoscope, the hematoma was aspirated or resected in blocks. During the operation, mini aneurysm clamp was used to clamp the responsible vessels, and hemostatic gauze was applied on the surface of the hematoma cavity. Silica gel external drainage tube was placed in the hematoma cavity.