Petridis Athanasios K, Barth Harald, Buhl Ralf, Hugo Heinz Hermann, Mehdorn H Maximilian
Department of Neurosurgery, University of Schleswig-Holstein, Campus Kiel, Schittenhelmstrasse 10, 24106, Kiel, Germany.
Acta Neurochir (Wien). 2008 Sep;150(9):889-95. doi: 10.1007/s00701-008-0001-y. Epub 2008 Aug 23.
Abnormal amyloid protein can be deposited in the wall of cerebral arteries leading to fragility and intracerebral haematoma in patients with cerebral amyloid angiopathy. Diagnosis can be done only histologically. The indication of surgically treating intracerebral haemorrhage caused by amyloid angiopathy is controversial. There are studies showing a high mortality and a high rate of recurrent bleeding. Others show almost no recurrent bleeding and a very low mortality and a third party states that even when recurrent intracerebral haemorrhage occurs, re-evacuation should be performed. In the present retrospective study a population of 99 patients suffering from cerebral amyloid angiopathy-related cerebral haemorrhage has been studied, to investigate the surgical outcome.
Ninety-nine patients were histologically diagnosed with cerebral amyloid angiopathy in our department from 1991-2004. The outcome has been established by the Glascow Outcome Score.
It could be shown that intraventricular bleeding and age >75 years increased the mortality after operative evacuation. Recurrent bleeding occurred in 22% of patients. After re-evacuation at least half of the patients survived leading to the suggestion to re-operate a recurrent bleeding since patients have a chance to survive even when the Glascow Outcome Score is 3. The overall mortality in the observed population was 16% and 11% had a very good neurological recovery based on a Glascow Outcome Score of 4-5. The operative outcome in amyloid angiopathy related intracerebral haemorrhage is similar to this of intracerebral haemorrhage induced by other causes like hypertensive bleeding.
Possible cerebral amyloid angiopathy is no contraindication for evacuation of brain-haematoma, and especially not in patients younger than 75 years old without an intraventricular haemorrhage.
异常淀粉样蛋白可沉积于脑动脉壁，导致脑淀粉样血管病患者出现血管脆性增加及颅内血肿。仅能通过组织学检查进行诊断。对于淀粉样血管病所致颅内出血进行手术治疗的指征存在争议。有研究显示死亡率高且再出血率高。其他研究则显示几乎无再出血情况，死亡率极低，还有第三方指出即便发生复发性颅内出血，也应进行再次血肿清除术。在本回顾性研究中，对99例患有脑淀粉样血管病相关性脑出血的患者群体进行了研究，以调查手术结果。
1991年至2004年期间，我科对99例患者进行了脑淀粉样血管病的组织学诊断。通过格拉斯哥预后评分确定结果。
结果显示，脑室内出血和年龄大于75岁会增加手术清除血肿后的死亡率。22%的患者发生了再出血。再次血肿清除术后，至少一半的患者存活，这表明对于复发性出血建议再次手术，因为即便格拉斯哥预后评分为3分，患者仍有存活机会。观察人群的总体死亡率为16%，11%的患者基于格拉斯哥预后评分为4 - 5分而有非常良好的神经功能恢复。淀粉样血管病相关性颅内出血的手术结果与其他原因（如高血压性出血）所致颅内出血的手术结果相似。
可能存在的脑淀粉样血管病并非脑血肿清除术的禁忌证，尤其是对于年龄小于75岁且无脑室内出血的患者。
