Wu Guofeng, Wang Fan, Wang Likun, Shi Jing, Yu Hui, Zhang Yingjun
Emergency Department, Affiliated Hospital, Guiyang Medical College, Guiyang City, Guizhou Province, PRC.
Department of Neurology, Affiliated Hospital, Guiyang Medical College, Guiyang City, Guizhou Province, PRC.
J Stroke Cerebrovasc Dis. 2017 Apr;26(4):701-710. doi: 10.1016/j.jstrokecerebrovasdis.2014.12.013. Epub 2017 Jan 6.
Diffusion tensor imaging was used to observe the effects of performing early minimally invasive surgery (MIS) on internal capsule in dog model of intracerebral hemorrhage (ICH).
Twenty-five male dogs were selected to prepare an ICH model, and then they were randomly distributed into a model control (MC) group (5 dogs) or an MIS group (20 dogs). In the MIS group, the intracerebral hematoma was evacuated by stereotactic minimally invasive procedures over 6 hours (5 dogs), 12 hours (5 dogs), 18 hours (5 dogs), or 24 hours (5 dogs) after successful induction of ICH. The same procedure was performed in the MC group but without evacuating the hematoma. All the animals were sacrificed within 2 weeks after the hematoma was surgically evacuated. The neurologic deficit score and diffusion tensor imaging (DTI) were observed before and after the MIS. The perihematomal blood-brain barrier (BBB) permeability and the brain water content (BWC) were measured 2 weeks after the hematoma was surgically evacuated.
The DTI demonstrated that integrity of the internal capsule restored largely after surgery and the fractional anisotropy (FA) values of the internal capsule on the hematoma side increased significantly as compared with those in the MC group or those before surgery in the same group. The postoperative ratios of FA values of each MIS subgroup increased compared with the MC group and those before surgery in the same subgroup before operation. The neurologic deficit score, the perihematomal BBB permeability, and the BWC of each MIS subgroup decreased significantly compared with those of the MC group. The 6-12-hour group displayed a more favorable result.
Performing the MIS in the early stage (6-12 hours) after ICH could decrease the secondary damages to the internal capsule so as to promote the recovery of motor function. The optimal time window for MIS should be within 6-12 hours after onset of ICH.
采用弥散张量成像观察早期微创手术（MIS）对脑出血（ICH）犬模型内囊的影响。
选取25只雄性犬制备ICH模型，然后将它们随机分为模型对照组（MC组，5只犬）或MIS组（20只犬）。在MIS组中，于成功诱导ICH后6小时（5只犬）、12小时（5只犬）、18小时（5只犬）或24小时（5只犬），通过立体定向微创手术清除脑内血肿。MC组进行相同操作，但不清除血肿。所有动物在血肿手术清除后2周内处死。观察MIS前后的神经功能缺损评分和弥散张量成像（DTI）。在血肿手术清除后2周测量血肿周围血脑屏障（BBB）通透性和脑含水量（BWC）。
DTI显示，术后内囊完整性大部分得以恢复，血肿侧内囊的各向异性分数（FA）值与MC组或同组术前相比显著增加。各MIS亚组术后FA值的比率与MC组及术前同亚组相比均升高。各MIS亚组的神经功能缺损评分、血肿周围BBB通透性和BWC与MC组相比均显著降低。6 - 12小时组效果更佳。
ICH后早期（6 - 12小时）进行MIS可减少对内囊的继发性损伤，从而促进运动功能恢复。MIS的最佳时间窗应为ICH发病后6 - 12小时内。
