基于丘脑血管区域的自发性丘脑出血的新型解剖学分类

Novel Anatomic Classification of Spontaneous Thalamic Hemorrhage Classified by Vascular Territory of Thalamus.

作者信息

Teramoto Shinichiro, Yamamoto Takuji, Nakao Yasuaki, Watanabe Mitsuya

机构信息

Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.

出版信息

World Neurosurg. 2017 Aug;104:452-458. doi: 10.1016/j.wneu.2017.05.059. Epub 2017 May 19.

DOI:10.1016/j.wneu.2017.05.059

PMID:28532917

Abstract

BACKGROUND

Spontaneous thalamic hemorrhage has increased in incidence in recent years. Analysis of the characteristics of thalamic hemorrhage was based on the vascular territories of the thalamus.

METHODS

Retrospective analysis included 303 consecutive patients with spontaneous thalamic hemorrhage. Thalamic hemorrhage was classified into 4 types: anterior type (supplied mainly by the tuberothalamic artery), medial (mainly paramedian thalamic-subthalamic artery), lateral (mainly thalamogeniculate artery), and posterior (mainly posterior choroidal artery). The baseline characteristics, complications, and functional outcomes were assessed.

RESULTS

The anterior type was found in 10 patients (3.3%), the medial type in 47 (15.5%), the lateral type in 230 (75.9%), and the posterior type in 16 (5.3%). Intracerebral hemorrhage volume was smallest in the anterior type, and significantly smaller than in the medial (P = 0.002) and lateral types (P < 0.001). Intraventricular hemorrhage (IVH) or acute hydrocephalus was significantly associated with the medial type (P < 0.01 or P < 0.01, respectively). Non-IVH or non-acute hydrocephalus was significantly associated with the anterior (P < 0.05 or P < 0.05, respectively) and lateral (P < 0.05 or P < 0.05, respectively) types. Emergency surgery was correlated only with the medial type (P < 0.01). The independent predictors of poor outcome were age (odds ratio [OR], 1.07; P = 0.002), admission National Institutes of Health Stroke Scale score (OR, 1.32; P < 0.001), and type of thalamic hemorrhage (OR, 2.08; P = 0.038).

CONCLUSIONS

The present study proposed a novel anatomic classification of thalamic hemorrhage according to the major thalamic vascular territories.

摘要

背景

近年来自发性丘脑出血的发病率有所上升。基于丘脑的血管区域对丘脑出血的特征进行分析。

方法

回顾性分析连续纳入的303例自发性丘脑出血患者。丘脑出血分为4型：前型（主要由丘脑结节动脉供血）、内侧型（主要由丘脑旁正中-底丘脑动脉供血）、外侧型（主要由丘脑膝状体动脉供血）和后型（主要由脉络膜后动脉供血）。评估基线特征、并发症和功能结局。

结果

前型10例（3.3%），内侧型47例（15.5%），外侧型230例（75.9%），后型16例（5.3%）。前型脑出血量最小，显著小于内侧型（P = 0.002）和外侧型（P < 0.001）。脑室内出血（IVH）或急性脑积水与内侧型显著相关（分别为P < 0.01或P < 0.01）。非IVH或非急性脑积水与前型（分别为P < 0.05或P < 0.05）和外侧型（分别为P < 0.05或P < 0.05）显著相关。急诊手术仅与内侧型相关（P < 0.01）。预后不良的独立预测因素为年龄（比值比[OR]，1.07；P = 0.002）、入院时美国国立卫生研究院卒中量表评分（OR，1.32；P < 0.001）和丘脑出血类型（OR，2.08；P = 0.038）。