Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
J Neurointerv Surg. 2022 Feb;14(2):149-154. doi: 10.1136/neurintsurg-2020-017077. Epub 2021 Mar 15.
Perihematomal edema (PHE) volume correlates with intracerebral hemorrhage (ICH) volume and is associated with functional outcome. Minimally invasive surgery (MIS) for ICH decreases clot burden and PHE. MIS may therefore alter the time course of PHE, mitigating a critical source of secondary injury.
To describe a new method for the quantitative measurement of cerebral edema surrounding the evacuated hematoma cavity, termed pericavity edema (PCE), and obtain details of its time course following MIS for ICH.
The study included 48 consecutive patients presenting with ICH who underwent MIS evacuation. Preoperative and postoperative CT scans were assessed by two independent raters. Hematoma, edema, cavity, and pneumocephalus volumes were calculated using semi-automatic, threshold-guided volume segmentation software (AnalyzePro). Follow-up CT scans at variable delayed time points were available for 36 patients and were used to describe the time course of PCE.
Mean preoperative, postoperative, and delayed PCE were 21.0 mL (SD 15.5), 18.6 mL (SD 11.4), and 18.4 mL (SD 15.5), respectively. The percentage of ICH evacuated correlated significantly with a decrease in postoperative PCE (r=-0.46, p<0.01). Linear regression analysis revealed a significant relation between preoperative hematoma volume and both postoperative PCE (p<0.001) and postoperative relative PCE (p<0.001). The mean peak PCE was 26.4 mL (SD 15.6) and occurred at 6.5 days (SD 4.8) post-ictus. The 2-week postoperative time course of relative PCE did not fluctuate, suggesting stability in edema during the perioperative period surrounding evacuation and up to 2 weeks after the initial bleed.
We present a detailed and accurate method for measuring PCE volume with semi-automatic, threshold-guided segmentation software in the postoperative patient with ICH. Decrease in PCE after MIS evacuation correlated with evacuation percentage, and relative PCE remained stable after minimally invasive endoscopic ICH evacuation.
血肿周围水肿（PHE）体积与脑内出血（ICH）体积相关，与功能预后相关。ICH 的微创手术（MIS）可降低血栓负荷和 PHE。因此，MIS 可能改变 PHE 的时间进程，减轻继发性损伤的关键来源。
描述一种新的方法，用于定量测量清除血肿腔周围的脑水肿，称为腔周水肿（PCE），并获得 MIS 治疗 ICH 后其时间进程的详细信息。
该研究纳入了 48 例接受 MIS 清除术治疗的 ICH 连续患者。两名独立的评估者评估术前和术后 CT 扫描。血肿、水肿、腔和气颅体积使用半自动、基于阈值的体积分割软件（AnalyzePro）进行计算。36 例患者有不同延迟时间点的随访 CT 扫描，用于描述 PCE 的时间进程。
平均术前、术后和延迟 PCE 分别为 21.0 mL（SD 15.5）、18.6 mL（SD 11.4）和 18.4 mL（SD 15.5）。ICH 清除百分比与术后 PCE 减少显著相关（r=-0.46，p<0.01）。线性回归分析显示，术前血肿体积与术后 PCE（p<0.001）和术后相对 PCE（p<0.001）均有显著关系。平均 PCE 峰值为 26.4 mL（SD 15.6），发生在发病后 6.5 天（SD 4.8）。术后 2 周相对 PCE 的时间进程没有波动，提示在清除后的围手术期和初始出血后 2 周内，水肿稳定。
我们提出了一种使用半自动、基于阈值的分割软件测量 ICH 术后患者 PCE 体积的详细、准确方法。MIS 清除术后 PCE 减少与清除百分比相关，微创内镜 ICH 清除术后相对 PCE 保持稳定。
