Kết quả bước đầu áp dụng kỹ thuật mở sọ tỉnh cho phẫu thuật cạnh bó, xâm lấn tối thiểu qua rãnh điều trị xuất huyết não=Awake minimally invasive trans-sulcal parafascicular surgery with monitored anesthesia care approach for spontaneous intracerebral hemorrhage

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Tác giả: Hoàng Quân Lê, Kính Khương Lưu

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.272-278

Bộ sưu tập: Báo, Tạp chí

ID: 243846

Thêm vào giỏ

Chuyên ngành gây mê thần kinh ngày càng chú trọng đến kỹ thuật vô cảm có thể tối ưu phẫu trường, bảo tồn chức năng thần kinh, đồng thời giảm biến chứng gây mê, giảm ảnh hưởng của gây mê đối với theo dõi thần kinh trong mổ, tỉnh mê êm dịu, nhằm đảm bảo bệnh nhân phục hồi nhanh, giảm biến chứng phẫu thuật và thời gian nằm viện. Mở sọ tỉnh có thể là lựa chọn phù hợp để hiện thực hóa các mục tiêu nêu trên, mở sọ tỉnh không chỉ cho phép lập bản đồ não trong mổ tránh tổn thương vùng não chức năng, còn giúp bệnh nhân có cơ hội phục hồi tốt, giảm thiểu gánh nặng gây mê và thở máy sau mổ. Mở sọ tỉnh phổ biến nhất là cắt u thần kinh đệm nằm gần hoặc trong vùng não chức năng, nhưng chỉ định đã mở rộng qua nhiều năm cho các tổn thương trên lều khác như túi phình, dị dạng động tĩnh mạch. Vai trò của nó đối với tổn thương xuất huyết não trên lều vẫn chưa được xác định. Chúng tôi đã thực hiện thành công năm ca mở sọ tỉnh lấy máu tụ trong não trên lều trong thời gian này. Không có biến chứng nghiêm trọng trong mổ, thất bại mở sọ tỉnh hoặc chuyển sang gây mê. Kết quả bước đầu áp dụng kỹ thuật mở sọ tỉnh cho phẫu thuật cạnh bó xâm lấn tối thiểu qua rãnh điều trị xuất huyết não tại Bệnh viện Đa khoa Tâm Anh cho thấy phương pháp này an toàn và khả thi.The neuroanaesthesia specialty increasingly emphasis on providing optimal surgical conditions, preservation of neurological functions, also reduction the complications of general anaesthesia, minimal interference on intraoperative neurophysiological monitoring, smooth recovery from anaesthesia for neurosurgical patients to ensure quick recovery, minimal surgical complications and reduce the length of hospital stay. Awake craniotomy may be an appropriate approach to actualize the above goals, since awake craniotomy not only allows intraoperative brain mapping to prevent injury to the eloquent brain regions, but also provides the patient the best possible chance of recovery and minimizes the burden associated with general anaesthesia and postoperative ventilation. The most common surgical indication for awake craniotomy is resection of gliomas, located within or close to the eloquent areas of the brain, although the indication for awake craniotomy has been extended over the years to include other supratentorial lesions such as intracerebral aneurysm, arteriovenous malformation. Its role in supratentorial intracerebral hemorrhage remains undetermined. We performed five successful awake craniotomies for supratentorial intracerebral hemorrhage evacuation under monitored anesthesia care within the period. There was no serious intraoperative complication, failure of AC or conversion into general anaesthesia. Our preliminary results of applying the awake craniotomy for supratentorial intracerebral hemorrhage evacuation by minimally invasive trans-sulcal parafascicular surgery at Tam Anh Hospital show this method is safe and feasible.

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