Cheng Yuan, Chen Jin, Zhao Guanjian, Xie Zongyi, Huang Ning, Yang Qiang, Chen Weifu, Huang Qin
Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Neurol. 2021 Jan 12;11:561781. doi: 10.3389/fneur.2020.561781. eCollection 2020.
Spontaneous intracerebral hemorrhage (ICH) is a devastating disease with higher mortality and disability rates; however, ideal surgical management is still to be determined for critical ICH. The purpose of this study was to prove the feasibility and unique clinical value of a novel combination, decompressive hemicraniectomy associated with ultrasound-guided minimally invasive puncture and drainage (DH + MIPD), for deteriorating ICH in the basal ganglia region. According to the enrollment criteria, 168 ICH patients were analyzed retrospectively, of which 86 patients received DH + MIPD and 82 patients received DH associated with traditional hematoma evacuation as the control group. The change process of three parameters, including hematoma size, peri-hematoma edema, and intracranial pressure (ICP), in a period of time after operation, as well as the short- and long-term therapeutic effect, was compared. The DH + MIPD method could effectively achieve the evacuation rate of hematoma up to 87% at 5 days post-operation and had the significant advantages of minimal injury to cerebral tissue, less degree of edema, better effect of decreasing ICP, shorter operation time, less blood loss, and lower mortality compared with the control method. The DH + MIPD group had a significantly higher survival rate within 1 year post-operation ( = 0.007) and better functional outcome at 90 and 180 days post-operation ( = 0.004). A subgroup analysis pointed out that the DH + MIPD method had a definite survival advantage for critical ICH patients older than 60 years old and with hematoma located in the left dominant hemisphere. Our results proved the better feasibility of DH + MIPD on hematoma evacuation and implicated its significant advantages of reducing mortality and improving functional recovery. This method provides one more choice for the individualized therapy of ICH in the basal ganglia region.
自发性脑出血（ICH）是一种具有较高死亡率和致残率的灾难性疾病；然而，对于重症脑出血，理想的手术治疗方法仍有待确定。本研究的目的是证明一种新型联合手术——去骨瓣减压术联合超声引导下微创穿刺引流术（DH + MIPD）治疗基底节区恶化性脑出血的可行性及独特的临床价值。根据纳入标准，对168例脑出血患者进行回顾性分析，其中86例患者接受DH + MIPD治疗，82例患者接受去骨瓣减压术联合传统血肿清除术作为对照组。比较术后一段时间内血肿大小、血肿周围水肿和颅内压（ICP）这三个参数的变化过程，以及短期和长期治疗效果。DH + MIPD方法术后5天血肿清除率可达87%，与对照方法相比，具有对脑组织损伤最小、水肿程度较轻、降低ICP效果更好、手术时间短、失血量少和死亡率低等显著优势。DH + MIPD组术后1年内生存率显著更高（ = 0.007），术后90天和180天时功能预后更好（ = 0.004）。亚组分析指出，DH + MIPD方法对年龄大于60岁且血肿位于左侧优势半球的重症脑出血患者具有明确的生存优势。我们的结果证明了DH + MIPD在血肿清除方面具有更好的可行性，并表明其在降低死亡率和改善功能恢复方面具有显著优势。该方法为基底节区脑出血的个体化治疗提供了又一种选择。
