Department of Neurosurgery, Rabin Medical Center, Petach Tikva, Israel.
Department of Neurosurgery, Sheba Medical Center, Ramat-Gan, Israel.
World Neurosurg. 2021 Jun;150:42-53. doi: 10.1016/j.wneu.2021.03.083. Epub 2021 Mar 23.
Spontaneous intracerebral hematoma (ICH) is a common disease with a dismal overall prognosis. Recent development of minimally invasive ICH evacuation techniques has shown promising results. Commercially available tubular retractors are commonly used for minimally invasive ICH evacuation yet are globally unavailable.
A novel U.S. $7 cost-effective, off-the-shelf, atraumatic tubular retractor for minimally invasive intracranial surgery is described. Patients with acute spontaneous ICH underwent microsurgical tubular retractor-assisted minimally invasive ICH evacuation using the novel retractor. Patient outcome was retrospectively analyzed and compared with open surgery and with commercial tubular retractors.
Ten adult patients with spontaneous supratentorial ICH and median preoperative Glasgow Coma Scale score of 10 were included. ICH involved the frontal lobe, parietal lobe, occipitotemporal region, and solely basal ganglia in 3, 3, 2, and 2 patients, respectively. Mean preoperative ICH volume was 80 mL. Mean residual hematoma volume was 8.7 mL and mean volumetric hematoma reduction was 91% (median, 94%). Seven patients (70%) underwent >90% volumetric hematoma reduction. The total median length of hospitalization was 26 days. On discharge, the median Glasgow Coma Scale score was 12.5 (mean, 11.7). Thirty to 90 days' follow-up data were available for 9 patients (90%). The mean follow-up modified Rankin Scale score was 3.7 and 5 patients (56%) had a modified Rankin Scale score of 3.
The novel cost-effective tubular retractor and microsurgical technique offer a safe and effective method for minimally invasive ICH evacuation. Cost-effective tubular retractors may continue to present a valid alternative to commercial tubular retractors.
自发性脑出血（ICH）是一种常见疾病，整体预后较差。微创 ICH 清除技术的最新发展显示出了良好的效果。市售的管状牵开器常用于微创 ICH 清除，但在全球范围内都无法获得。
介绍了一种新型、经济实惠、成本 7 美元、非创伤性的管状牵开器，用于微创颅内手术。采用新型牵开器对急性自发性 ICH 患者进行了显微管状牵开器辅助微创 ICH 清除。回顾性分析了患者的预后，并与开颅手术和商业管状牵开器进行了比较。
10 例成人幕上自发性 ICH 患者纳入本研究，术前格拉斯哥昏迷量表评分中位数为 10 分。ICH 分别累及额叶、顶叶、枕颞叶和单纯基底节 3、3、2、2 例。术前 ICH 体积平均为 80ml。平均残余血肿量为 8.7ml，血肿体积减少率平均为 91%（中位数为 94%）。7 例（70%）患者的血肿体积减少率>90%。总住院中位数为 26 天。出院时格拉斯哥昏迷量表评分为中位数 12.5 分（平均 11.7 分）。9 例（90%）患者可获得 30-90 天的随访数据。平均随访改良 Rankin 量表评分为 3.7 分，5 例（56%）患者改良 Rankin 量表评分为 3 分。
新型经济实惠的管状牵开器和显微外科技术为微创 ICH 清除提供了一种安全有效的方法。经济实惠的管状牵开器可能继续成为商业管状牵开器的有效替代方案。
