Department of Neurology, University of California, San Francisco, San Francisco, California.
Main Line Health, Wynnewood, Pennsylvania, USA.
Curr Opin Crit Care. 2020 Apr;26(2):129-136. doi: 10.1097/MCC.0000000000000695.
Spontaneous intracerebral hemorrhage (ICH) is common, associated with a high degree of mortality and long-term functional impairment, and remains without effective proven treatments. Surgical hematoma evacuation can reduce mass effect and decrease cytotoxic effects from blood product breakdown. However, results from large clinical trials that have examined the role of open craniotomy have not demonstrated a significant outcome benefit over medical management. We review the data on minimally invasive surgery (MIS) that is emerging as a treatment modality for spontaneous ICH.
The use of MIS for supratentorial ICH has increased significantly in recent years and appears to be associated with decreased mortality and improved functional outcome compared with medical management. The role of MIS for posterior fossa ICH is ill-defined. Currently available MIS devices allow for stereotactic aspiration and thrombolysis, endoport-mediated evacuation, and endoscopic aspiration. Clinical series demonstrate that MIS can facilitate significant hematoma volume reduction and may be associated with less morbidity than conventional open surgical approaches.
MIS is an appealing treatment modality for supratentorial ICH and with careful patient selection and technologic advances has the potential to improve neurologic outcomes and reduce mortality. Early and extensive hematoma evacuation are important therapeutic targets and current studies are underway that have the potential to change the management for ICH patients.
自发性脑出血（ICH）很常见，死亡率和长期功能障碍程度高，且目前尚无有效的治疗方法。手术血肿清除可减轻占位效应并减少血细胞分解产物的细胞毒性作用。然而，大型临床试验对开颅手术作用的研究结果并未表明其在改善预后方面明显优于药物治疗。我们对微创外科（MIS）的研究数据进行了综述，MIS 作为自发性 ICH 的治疗方法已逐渐兴起。
近年来，MIS 治疗幕上 ICH 的应用显著增加，与药物治疗相比，死亡率降低，功能结局改善。MIS 治疗后颅窝 ICH 的作用尚未明确。目前可用的 MIS 设备可进行立体定向抽吸和溶栓、经端口介导的清除以及内镜抽吸。临床系列研究表明，MIS 可显著减少血肿体积，且与传统开颅手术方法相比，可能具有更低的发病率。
MIS 是幕上 ICH 的一种有吸引力的治疗方法，通过精心选择患者和技术进步，有可能改善神经功能预后并降低死亡率。早期和广泛的血肿清除是重要的治疗目标，目前正在进行的研究有可能改变 ICH 患者的治疗管理。
