Department of Neurosurgery, Keck School of Medicine at University of Southern California, University of Southern California, Los Angeles, California, USA.
Department of Neurosurgery, Keck School of Medicine at University of Southern California, University of Southern California, Los Angeles, California, USA.
World Neurosurg. 2019 Dec;132:e520-e528. doi: 10.1016/j.wneu.2019.08.087. Epub 2019 Aug 23.
Spontaneous intracerebral hemorrhage (ICH) comprises 10%-15% of strokes with a high mortality (40%) and low rates of functional independence within 6 months (25%). Minimally invasive parafascicular surgery has emerged as a potentially safer option for ICH management.
Data from 25 patients who underwent channel-based ICH evacuation were retrospectively collected regarding demographics, clinical presentation, neuroimaging characteristics, follow-up modified Rankin Scale (mRS) score, Glasgow Coma Scale (GCS) score, and disposition.
Sixteen patients were male (64%) and 9 were female (36%), with a mean age of 52 years. There were 4 frontal, 1 occipital, and 20 basal ganglia hemorrhages; 15 (60%) showed intraventricular extension. Seventeen ICHs (68%) and 6 of 7 patient deaths (86%) were left sided. The mean volume was 46 cm (range, 13.1-101.2 cm), and the mean clot reduction was 92%. Left-sided ICH (P = 0.014) and the presence of intraventricular hemorrhage (P = 0.038) were associated with worsened postoperative GCS score. Larger hemorrhages were associated with mortality (66 cm vs. 38 cm; P < 0.005). With a mean follow-up time of 5 months, the median follow-up mRS score was 3.5 (vs. 4 preoperatively), and median follow-up GCS was 15 (vs. 10 preoperatively). Patients with higher postoperative mRS scores and lower postoperative GCS were more likely to die.
BrainPath-mediated transsulcal approaches are associated with improved mRS and GCS scores, with low rates of residual hematoma, although further data are needed via controlled studies to determine the importance of hemorrhage location and size, timing of surgical intervention, and long-term patient outcomes.
自发性脑出血（ICH）占中风的 10%-15%，死亡率高（40%），6 个月内功能独立率低（25%）。微创旁正中手术已成为治疗 ICH 的一种潜在更安全的选择。
回顾性收集了 25 例接受基于通道的 ICH 清除术的患者的数据，内容包括人口统计学资料、临床表现、神经影像学特征、随访改良 Rankin 量表（mRS）评分、格拉斯哥昏迷量表（GCS）评分和转归。
16 例患者为男性（64%），9 例为女性（36%），平均年龄为 52 岁。4 例位于额部，1 例位于枕部，20 例位于基底节区；15 例（60%）伴有脑室内延伸。17 例 ICH（68%）和 7 例患者死亡中的 6 例（86%）均位于左侧。平均血肿量为 46cm³（范围，13.1-101.2cm³），平均血肿清除率为 92%。左侧 ICH（P=0.014）和脑室内出血（P=0.038）与术后 GCS 评分恶化相关。较大的血肿与死亡率相关（66cm³与 38cm³；P＜0.005）。平均随访时间为 5 个月，中位随访 mRS 评分为 3.5（术前为 4 分），中位随访 GCS 为 15（术前为 10 分）。术后 mRS 评分较高和 GCS 评分较低的患者更有可能死亡。
BrainPath 介导的经侧裂入路与改善 mRS 和 GCS 评分相关，残余血肿率较低，尽管需要进一步的对照研究数据来确定出血部位和大小、手术干预时机以及长期患者预后的重要性。
