Background To observe the therapeutic effect of conventional decompressive craniectomy with hematoma evacuation and frame-based stereotactic minimally invasive surgery (MIS) for supratentorial intracranial hematoma with herniation. Methods One hundred forty-nine patients with hypertensive ICH complicated with tentorial herniation were reviewed and analyzed in the present study. The intracranial hematoma was evacuated by emergency surgery within 6 h after admission. According to the authorized representatives’ wishes and consent, 74 of the 149 patients were treated by conventional decompressive craniectomy followed by hematoma removal, defined as the CDC group, and the remaining 75 patients underwent frame-based stereotactic MIS for ICH evacuation, defined as the MIS group. The intervals between the admission to surgery, the duration of surgery, the amount of iatrogenic bleeding, the occurrence of postoperative rebleeding, and the recovery of neurological functions were compared between the two groups. All patients were followed up for 3 months. Secondary epilepsy, survival in a vegetative state, severe pulmonary complications, mortality, and activities of daily living (ADL) classification were also recorded and compared. Results The interval between admission and surgery, the duration of surgery, and intraoperative blood loss in the MIS group were significantly decreased compared to the CDC group. The mortality rate, the rate of rebleeding, prevalence of vegetative state, and severe pulmonary complications in the MIS group were remarkably decreased compared to the CDC group. In the MIS group, the survivors’ (ADL) grade also showed advantages. Conclusions In the surgical treatment of hypertensive ICH complicated with tentorial herniation, frame-based stereotactic MIS for ICH showed advantages compared to conventional open surgery.

中文翻译：

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脑出血伴天幕疝：常规开放手术还是紧急立体定向颅穿刺抽吸手术？

背景 观察常规去骨瓣减压联合血肿清除术和基于框架的立体定向微创手术（MIS）治疗幕上颅内血肿伴疝的疗效。方法对149例高血压脑出血合并小脑幕疝患者进行回顾分析。入院后6 h内通过急诊手术清除颅内血肿。根据授权代表的意愿和同意，149 例患者中，74 例接受常规去骨瓣减压术后血肿清除术，定义为 CDC 组，其余 75 例患者接受基于框架的立体定向 MIS 进行 ICH 清除，定义为管理信息系统组。入院时间、手术时间、比较两组医源性出血量、术后再出血发生情况、神经功能恢复情况。所有患者均随访3个月。还记录并比较了继发性癫痫、植物人存活率、严重肺部并发症、死亡率和日常生活活动 (ADL) 分类。结果 MIS组患者入院至手术时间、手术时间、术中出血量均明显低于CDC组。与CDC组相比，MIS组的死亡率、再出血率、植物人患病率和严重肺部并发症显着降低。在 MIS 组中，幸存者（ADL）等级也显示出优势。