Tokairin Kikutaro, Kazumata Ken, Uchino Haruto, Ito Masaki, Ono Kota, Tatezawa Ryota, Shindo Takafumi, Kawabori Masahito, Nakayama Naoki, Houkin Kiyohiro
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita, Sapporo, Japan.
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita, Sapporo, Japan.
World Neurosurg. 2018 Dec;120:e593-e600. doi: 10.1016/j.wneu.2018.08.132. Epub 2018 Aug 27.
In combined revascularization surgery for patients with moyamoya disease, intracerebral hemorrhage (ICH) during the postoperative acute phase is a rarely observed but severe complication. Its clinical features remain unclear because of its low incidence rate. The aim of this study was to clarify the clinical characteristics of immediate postoperative ICH.
The frequency, onset timing, and hematoma location of patients who demonstrated immediate postoperative ICH were investigated in 201 consecutive surgeries performed in 134 patients. Associations between immediate postoperative ICH and demographics, clinical presentation type, perioperative blood pressure (BP), and neuroimaging data were analyzed.
Postoperative ICH was observed in 6 cases (2.99%; mean age, 46.0 ± 7.6 years). The onset timing of ICH was within 24 hours after surgery in most patients (83.3%). Hematomas were located at the subcortical lesion beneath the anastomosed cortex (n = 5) and caudate head (n = 1). Three cases (50.0%) required hematoma evacuation. A higher age at surgery was associated with postoperative ICH (P = 0.046). In adult cases (132 surgeries, 65.7%), hemorrhagic presentation at onset (P = 0.0027) and an increase in BP from pre- to postoperative stage (systolic BP increase: P = 0.0058, diastolic BP increase: P = 0.0274) were significantly associated with postoperative ICH.
The results suggest that older patients, with hemorrhagic presentation and greater postoperative BP increase, should be carefully managed to avoid postoperative ICH. Immediate hematoma evacuation may be effective in preventing devastating outcomes after postoperative ICH.
在烟雾病患者的联合血运重建手术中，术后急性期脑出血（ICH）是一种罕见但严重的并发症。由于其发病率低，其临床特征仍不清楚。本研究的目的是阐明术后即刻脑出血的临床特征。
在134例患者进行的201例连续手术中，调查了术后即刻发生脑出血患者的频率、发病时间和血肿位置。分析了术后即刻脑出血与人口统计学、临床表现类型、围手术期血压（BP）和神经影像学数据之间的关联。
6例（2.99%；平均年龄46.0±7.6岁）出现术后脑出血。大多数患者（83.3%）的脑出血发病时间在术后24小时内。血肿位于吻合皮层下方的皮质下病变处（n = 5）和尾状核头部（n = 1）。3例（50.0%）需要进行血肿清除。手术时年龄较大与术后脑出血相关（P = 0.046）。在成人病例（132例手术，65.7%）中，发病时的出血表现（P = 0.0027）以及从术前到术后阶段血压升高（收缩压升高：P = 0.0058，舒张压升高：P = 0.0274）与术后脑出血显著相关。
结果表明，对于年龄较大、有出血表现且术后血压升高幅度较大的患者，应谨慎管理以避免术后脑出血。即刻血肿清除可能对预防术后脑出血后的灾难性后果有效。
