Proust F, Leveque S, Derrey S, Tollard E, Vandhuick O, Clavier E, Langlois O, Fréger P
Staff neurovasculaire, service de neurochirurgie, CHU de Rouen, boulevard Gambetta, 76031 Rouen cedex, France.
Neurochirurgie. 2007 Jun;53(2-3 Pt 1):58-65. doi: 10.1016/j.neuchi.2006.12.003.
Until very recently, no specific therapies have been demonstrated to improve outcome after spontaneous intracerebral haemorrhage (ICH). The STICH (surgical treatment for intracerebral haemorrhage) study showed no overall benefit from early surgery when compared with initial conservative treatment. In contrast, the stereotactic aspiration technique can be safely performed and in a uniform manner. Despite the reduction of ICH volume, no improvement in mortality and functional result was obtained. Endoscopy is a new therapeutic option for ICH with good results for hematoma removal. Based on these feasibility studies, a randomized control trial regarding this procedure would be required to assess the efficacy of this procedure. Due to the lack of benefit observed in the recent STICH trial, emergency surgical evacuation should be reserved for patients with large lobar haemorrhage, mass effect and rapidly deteriorating clinical condition.
直到最近，尚无特定疗法被证实可改善自发性脑出血（ICH）后的预后。脑出血手术治疗（STICH）研究表明，与初始保守治疗相比，早期手术并无总体益处。相比之下，立体定向抽吸技术可以安全且统一地实施。尽管脑出血体积有所减少，但死亡率和功能结果并未得到改善。内镜检查是脑出血的一种新的治疗选择，在清除血肿方面效果良好。基于这些可行性研究，需要针对该手术进行一项随机对照试验，以评估其疗效。由于在最近的STICH试验中未观察到益处，紧急手术清除血肿应仅适用于有大量脑叶出血、占位效应且临床状况迅速恶化的患者。
