Thiex Ruth, Rohde Veit, Rohde Ina, Mayfrank Lothar, Zeki Zeliha, Thron Armin, Gilsbach Joachim M, Uhl Eberhard
Department of Neurosurgery, Aachen University, Pauwelsstr. 30, 52057, Aachen, Germany.
J Neurol. 2004 Dec;251(12):1443-50. doi: 10.1007/s00415-004-0554-5.
Comparison of two minimally invasive procedures for the treatment of intracerebral hemorrhage and subsequent lysis with regard to technical implications and clinical outcome of the patients.
Retrospective analysis of 126 patients with spontaneous supratentorial intracerebral hemorrhage treated by frame-based (n=53) or frameless (n=75) hematoma aspiration and subsequent fibrinolysis with recombinant tissue plasminogen activator (rt-PA). Data were analysed for the whole group as well as for the two subsets of patients with regard to hematoma reduction, procedure-related complications, and the early and long term clinical outcome of the patients. Functional outcome was rated using the Glasgow Outcome Scale (GOS) and Barthel-Index (median follow-up 178 weeks). The prognostic impact of patient related covariates on the GOS was analysed using logistic regression analysis.
49 out of 126 patients (38.9 %) died, 25 of them in the early postoperative period. Only 22/126 (17.5 %) had a favorable long term outcome (GOS >3). Age > 65 years was significantly (p<0.03, OR 3.6) associated with a higher risk for an unfavorable long term outcome (GOS < or = 3). Treatment had no impact on outcome. Both techniques were highly effective in reducing the intracerebral blood volume by 75.8+/-21.4% of the initial hematoma volume in frame-based and 64.8+/-25.4 % in frameless stereotaxy within 2 days of rt-PA-therapy. Malpositioning of the catheter occurred more often in the frameless group (21.3% vs. 9.4 % in the frame-based procedure) without gaining statistical significance.
Frame-based and frameless stereotactic hematoma aspirations with subsequent fibrinolysis are effective in volume reduction of intracerebral hemorrhage with comparable clinical outcome. The frameless procedure is associated with a higher risk for malpositioning of the catheter. Despite effective hematoma reduction with both techniques, the percentage of patients with a good clinical outcome remained limited especially in the elder subpopulation.
比较两种治疗脑出血及后续溶解的微创手术在技术影响和患者临床结局方面的差异。
对126例自发性幕上脑出血患者进行回顾性分析，这些患者接受了基于框架（n = 53）或无框架（n = 75）血肿抽吸术，并随后使用重组组织型纤溶酶原激活剂（rt-PA）进行纤溶治疗。分析了整个组以及两个患者亚组在血肿减少、手术相关并发症以及患者的早期和长期临床结局方面的数据。使用格拉斯哥预后量表（GOS）和巴氏指数（中位随访178周）对功能结局进行评分。使用逻辑回归分析分析患者相关协变量对GOS的预后影响。
126例患者中有49例（38.9%）死亡，其中25例在术后早期死亡。只有22/126（17.5%）患者有良好的长期结局（GOS>3）。年龄>65岁与不良长期结局（GOS≤3）的较高风险显著相关（p<0.03，OR 3.6）。治疗对结局无影响。在rt-PA治疗的2天内，两种技术在减少脑内血容量方面均非常有效，基于框架的方法使初始血肿体积减少75.8±21.4%，无框架立体定向方法使初始血肿体积减少64.8±25.4%。导管位置不当在无框架组中更常见（21.3%对基于框架手术中的9.4%），但未达到统计学显著性。
基于框架和无框架立体定向血肿抽吸术及随后的纤溶治疗在减少脑出血体积方面有效，临床结局相当。无框架手术与导管位置不当的较高风险相关。尽管两种技术在减少血肿方面均有效，但具有良好临床结局的患者百分比仍然有限，尤其是在老年亚组中。
