Miki Koichi, Yagi Kenji, Nonaka Masani, Iwaasa Mitsutoshi, Abe Hiroshi, Morishita Takashi, Arima Hisatomi, Inoue Tooru
1Department of Neurosurgery.
2Department of Emergency and Critical Care, and.
J Neurosurg. 2018 May 25;130(5):1485-1490. doi: 10.3171/2017.12.JNS172335. Print 2019 May 1.
In patients with spontaneous intracerebral hemorrhage (sICH), postoperative recurrent hemorrhage (PRH) is one of the most severe complications after endoscopic evacuation of hematoma (EEH). However, no predictors of this complication have been identified. In the present study, the authors retrospectively investigated whether PRH can be preoperatively predicted by the presence of the spot sign on CT scans.
In total, 143 patients with sICH were treated by EEH between June 2009 and March 2017, and 127 patients who underwent preoperative CT angiography were included in this study. Significant correlations of PRH with the patients' baseline, clinical, and radiographic characteristics, including the spot sign, were evaluated using multivariable logistic regression models.
The incidence of and risk factors for PRH were assessed in 127 patients with available data. PRH occurred in 9 (7.1%) patients. Five (21.7%) cases of PRH were observed among 23 patients with the spot sign, whereas only 4 (3.8%) cases of PRH occurred among 104 patients without the spot sign. The spot sign was the only independent predictor of PRH (OR 5.81, 95% CI 1.26-26.88; p = 0.02). The following factors were not independently associated with PRH: age, hypertension, poor consciousness, antihemostatic factors (thrombocytopenia, coagulopathy, and use of antithrombotic drugs), the location and size of the sICH, other radiographic findings (black hole sign and blend sign), surgical duration and procedures, and early surgery.
The spot sign is likely to be a strong predictor of PRH after EEH among patients with sICH. Complete and careful control of bleeding in the operative field should be ensured when surgically treating such patients. New surgical strategies and procedures might be needed to improve these patients' outcomes.
在自发性脑出血（sICH）患者中，术后再出血（PRH）是内镜下血肿清除术（EEH）后最严重的并发症之一。然而，尚未确定该并发症的预测因素。在本研究中，作者回顾性研究了CT扫描上的斑点征是否可用于术前预测PRH。
2009年6月至2017年3月期间，共有143例sICH患者接受了EEH治疗，本研究纳入了127例行术前CT血管造影的患者。使用多变量逻辑回归模型评估PRH与患者基线、临床和影像学特征（包括斑点征）之间的显著相关性。
对127例有可用数据的患者评估了PRH的发生率和危险因素。9例（7.1%）患者发生了PRH。在23例有斑点征的患者中观察到5例（21.7%）PRH，而在104例无斑点征的患者中仅发生4例（3.8%）PRH。斑点征是PRH的唯一独立预测因素（OR 5.81，95%CI 1.26 - 26.88；p = 0.02）。以下因素与PRH无独立相关性：年龄、高血压、意识障碍、止血因素（血小板减少、凝血障碍和使用抗血栓药物）、sICH的位置和大小、其他影像学表现（黑洞征和融合征）、手术持续时间和手术方式以及早期手术。
斑点征可能是sICH患者EEH后PRH的有力预测因素。在手术治疗此类患者时，应确保手术视野出血得到完全且仔细的控制。可能需要新的手术策略和方法来改善这些患者的预后。
