Sirh Sooji, Park Hye Ran
Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul, Korea.
J Cerebrovasc Endovasc Neurosurg. 2018 Jun;20(2):96-105. doi: 10.7461/jcen.2018.20.2.96. Epub 2018 Jun 30.
Minimally invasive techniques such as stereotactic aspiration have been regarded as promising alternative methods to replace craniotomy in the treatment of intracerebral hemorrhage (ICH). The aim of this study was to identify the optimal timing of stereotactic aspiration and analyze the factors affecting the clinical outcome.
This retrospective study included 81 patients who underwent stereotactic aspiration for spontaneous supratentorial ICH at single institution. Volume of hematoma was calculated based on computed tomography scan at admission, just before aspiration, immediately after aspiration, and after continuous drainage. The neurologic outcome was compared with Glasgow outcome scale (GOS) score.
The mean volume ratio of residual hematoma was 59.5% and 17.6% immediately after aspiration and after continuous drainage for an average of 2.3 days, respectively. Delayed aspiration group showed significantly lower residual volume ratio immediately after aspiration. However, there was no significant difference in the residual volume ratio after continuous drainage. The favorable outcome of 1-month GOS 4 or 5 was significantly better in the group with delayed aspiration after more than 7 days ( = 0.029), despite no significant difference in postoperative 6-months GOS score. A factor which has significant correlation with postoperative 6-months favorable outcome was the final hematoma volume ratio after drainage ( = 0.028).
There is no difference in final residual volume of hematoma or 6-months neurologic outcome according to the surgical timing of hematoma aspiration. The only factor affecting the postoperative 6-months neurologic outcome is the final volume of remaining hematoma after drainage.
立体定向抽吸等微创技术被视为在脑出血（ICH）治疗中替代开颅手术的有前景的替代方法。本研究的目的是确定立体定向抽吸的最佳时机，并分析影响临床结局的因素。
这项回顾性研究纳入了在单一机构接受立体定向抽吸治疗自发性幕上脑出血的81例患者。根据入院时、抽吸前、抽吸后即刻以及持续引流后的计算机断层扫描计算血肿体积。将神经功能结局与格拉斯哥结局量表（GOS）评分进行比较。
抽吸后即刻和平均持续引流2.3天后残余血肿的平均体积比分别为59.5%和17.6%。延迟抽吸组在抽吸后即刻的残余体积比显著更低。然而，持续引流后的残余体积比没有显著差异。在7天以上延迟抽吸的组中，1个月时GOS 4或5的良好结局显著更好（P = 0.029），尽管术后6个月GOS评分没有显著差异。与术后6个月良好结局有显著相关性的一个因素是引流后最终血肿体积比（P = 0.028）。
根据血肿抽吸的手术时机，血肿的最终残余体积或6个月神经功能结局没有差异。影响术后6个月神经功能结局的唯一因素是引流后剩余血肿的最终体积。
