Kim I-S, Son B-C, Lee S-W, Sung J-H, Hong J-T
Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, Suwon, Korea.
Minim Invasive Neurosurg. 2007 Apr;50(2):86-90. doi: 10.1055/s-2007-982503.
This study compared the technical implications and clinical outcome of patients treated for an intracerebral hemorrhage using two minimally invasive procedures: frame-based stereotactic hematoma aspiration and frameless navigation-guided hematoma aspiration followed by fibrinolysis.
Thirty patients with a spontaneous supratentorial intracerebral hemorrhage, which was treated by a frame-based (n=15) and frameless (n=15) hematoma aspiration followed by subsequent fibrinolysis with urokinase, were retrospectively reviewed. The data for the two subsets of patients were analyzed with regard to hematoma reduction, Glasgow Coma Scale (GCS), and degree of weakness.
In the frame-based stereotactic hematoma aspiration group, the volume of the hematoma was 15.4-100.0 mL (mean: 40.7+/-24.4), the GCS upon admission was 4-15 (mean: 10.1+/-3.0), and the grade of weakness upon admission was 1-5 (mean: 2.1+/-0.9). On the other hand, in the frameless navigation-guided hematoma aspiration group, the hematoma volume was 15.2-62.0 mL (mean: 30.0+/-15.2), the GCS upon admission was 7-15 (mean: 13.0+/-2.4), and the grade of weakness upon admission was 1-4 (mean: 2.3+/-1.2). The drainage catheter was in place for a mean duration of 5.1+/-2.4 days (range: 1-12 days). In the frame-based group, the initial hematoma was reduced by -115-88.5% (mean: 52+/-31.5) immediately after surgery, and 90.5% (41-100%) of the initial volume 14 days after surgery. In the frameless group, the initial hematoma was reduced by 11.7-90.8% (mean 57.3+/-25.1) immediately after surgery and 95.8% (87.7-100%) 14 days after surgery. The GCS score and the degree of weakness were evaluated 14 days after surgery, and the Glasgow outcome scale (GOS) score was evaluated at discharge. There were no statistically significant differences between the two groups.
The frame-based group and the frameless group followed by fibrinolysis had similar outcomes, and both procedures effectively reduced the intracerebral hemorrhage volume within a short period of time. In addition, these procedures are simple, precise, safe, and brief with a very low rebleeding rate and mortality.
本研究比较了采用两种微创手术治疗脑出血患者的技术影响和临床结果：基于框架的立体定向血肿抽吸术和无框架导航引导血肿抽吸术并随后进行纤维蛋白溶解。
回顾性分析30例自发性幕上脑出血患者，其中15例采用基于框架的血肿抽吸术，15例采用无框架血肿抽吸术，随后均用尿激酶进行纤维蛋白溶解。分析两组患者在血肿缩小、格拉斯哥昏迷量表（GCS）评分及虚弱程度方面的数据。
基于框架的立体定向血肿抽吸术组，血肿体积为15.4 - 100.0 mL（平均：40.7±24.4），入院时GCS评分为4 - 15分（平均：10.1±3.0），入院时虚弱程度分级为1 - 5级（平均：2.1±0.9）。另一方面，在无框架导航引导血肿抽吸术组，血肿体积为15.2 - 62.0 mL（平均：30.0±15.2），入院时GCS评分为7 - 15分（平均：13.0±2.4），入院时虚弱程度分级为1 - 4级（平均：2.3±1.2）。引流管留置的平均时间为5.1±2.4天（范围：1 - 12天）。在基于框架的组中，术后即刻初始血肿减少了115 - 88.5%（平均：52±31.5），术后14天减少了初始体积的90.5%（41 - 100%）。在无框架组中，术后即刻初始血肿减少了11.7 - 90.8%（平均57.3±25.1），术后14天减少了95.8%（87.7 - 100%）。术后14天评估GCS评分和虚弱程度，出院时评估格拉斯哥预后量表（GOS）评分。两组之间无统计学显著差异。
基于框架的组和无框架并随后进行纤维蛋白溶解的组结果相似，两种手术均能在短时间内有效减少脑出血体积。此外，这些手术操作简单、精确、安全且时间短，再出血率和死亡率极低。
