Deinsberger W, Lang C, Hornig C, Boeker D K
Neurosurgical Clinic, Justus Liebig University, Giessen, Germany.
Zentralbl Neurochir. 2003;64(4):145-50. doi: 10.1055/s-2003-44617.
Since introduction of stereotactic aspiration and fibrinolysis into the treatment of deep-seated intracerebral hematomas by Hondo and Matsumoto 1984 this method has become widely used, and satisfactory morphological results are achieved. Nevertheless, whether the outcome is improved has not yet been investigated.
17 patients with spontaneous intracerebral hematomas have been treated surgically; after angiographic exclusion of a vascular malformation stereotactic aspiration and fibrinolysis with 3 mg rTPA was performed. Between 1992 and 1995 104 patients were treated conservatively according to best medical treatment. From this group "matched pairs" with the surgical patients were set up concurring in primary (consciousness, size and location of the hematoma) and secondary parameters (age, sex, ventricular hemorrhage). Endpoint of the study was the Glasgow outcome score (GOS) six months after treatment. Data were analyzed statistically and p < 0.05 was considered significant.
In respect of primary parameters complete concurrence and regarding secondary parameters far-reaching concurrence was achieved. In no parameter the surgical and conservative group were significantly different from each other. Six months after the ictus no significant difference between surgical and conservative treatment concerning GOS could be established.
These results indicate that patients do not benefit from stereotactic aspiration and fibrinolysis of putamenal hematomas. For a final treatment recommendation a prospective randomised trial is required.
自1984年本藤和松本将立体定向抽吸和纤维蛋白溶解术引入深部脑内血肿治疗以来，该方法已被广泛应用，并取得了满意的形态学效果。然而，其疗效是否得到改善尚未得到研究。
对17例自发性脑内血肿患者进行了手术治疗；在血管造影排除血管畸形后，进行了立体定向抽吸并用3mg重组组织型纤溶酶原激活剂（rTPA）进行纤维蛋白溶解。1992年至1995年期间，104例患者根据最佳药物治疗进行保守治疗。从该组中选取与手术患者在主要参数（意识、血肿大小和位置）和次要参数（年龄、性别、脑室出血）上一致的“匹配对”。研究终点为治疗后6个月的格拉斯哥预后评分（GOS）。对数据进行统计学分析，p<0.05被认为具有显著性。
在主要参数方面实现了完全一致，在次要参数方面实现了高度一致。在任何参数上，手术组和保守组之间均无显著差异。发病6个月后，手术治疗和保守治疗在GOS方面无显著差异。
这些结果表明，患者不能从壳核血肿的立体定向抽吸和纤维蛋白溶解术中获益。为得出最终的治疗建议，需要进行一项前瞻性随机试验。
