Rho Sihyun, Kim Tae Sun, Joo Sung Pil, Gong Tae Sik, Kim Hyo Joon, Park Min
Department of Neurosurgery, Presbyterian Medical Center, Jeonju, Korea.
Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Korea.
J Cerebrovasc Endovasc Neurosurg. 2022 Jun;24(2):121-128. doi: 10.7461/jcen.2021.E2021.08.009. Epub 2021 Oct 26.
The surgical method for treating spontaneous intracranial hemorrhage (ICH) is not well established despite ICH's high prevalence and poor prognosis. Minimally invasive surgery has recently received attention; however, literature on this method is scarce. In particular, the appropriate location of the catheter in the hematoma has not been described. We examined whether the catheter position affects the hematoma reduction in a hematoma ＞50 cc.
We investigated the prognoses of 36 patients with ICH who underwent stereotactic aspiration and hematoma drainage using urokinase from January 2010 to December 2018 and the hematoma reduction rates according to the tube position. Two methods evaluated the position of the catheter. In the first method, the hematoma was an imaginary sphere. The center point was set as the operation target. We evaluated the catheter position by determining whether it was in the deep part or the outer part of the half point from that location to the hematoma margin. In the second method, we evaluated whether the catheter was located 1 cm inside the hematoma margin.
In both the first and second evaluations, there were no differences in age, midline shift, intraventricular hemorrhage status, hematoma volume on admission, Glasgow Coma Scale score on admission, time to operation after symptom onset, and systolic blood pressure. The rates of decrease in bleeding and the prognoses were also not significantly different.
If the catheter is in the hematoma, the rate of hematoma reduction at any position is similar.
尽管自发性颅内出血（ICH）患病率高且预后差，但治疗该疾病的手术方法尚未完全确立。最近，微创手术受到了关注；然而，关于这种方法的文献却很稀少。特别是，尚未描述导管在血肿中的合适位置。我们研究了对于血肿＞50 cc的情况，导管位置是否会影响血肿的减少。
我们调查了2010年1月至2018年12月期间36例行立体定向抽吸并用尿激酶进行血肿引流的ICH患者的预后，以及根据导管位置的血肿减少率。有两种方法评估导管位置。第一种方法中，将血肿视为一个假想球体。将中心点设为手术靶点。我们通过确定导管是在从该位置到血肿边缘一半处的深部还是外部来评估导管位置。在第二种方法中，我们评估导管是否位于血肿边缘内1 cm处。
在第一次和第二次评估中，患者年龄、中线移位、脑室内出血情况、入院时血肿体积、入院时格拉斯哥昏迷量表评分、症状发作后至手术的时间以及收缩压均无差异。出血减少率和预后也无显著差异。
如果导管位于血肿内，则任何位置的血肿减少率相似。
