Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Neurology, 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.
World Neurosurg. 2022 May;161:e289-e294. doi: 10.1016/j.wneu.2022.01.123. Epub 2022 Feb 5.
Recent publications on minimally invasive surgery (MIS) for hematoma evacuation have suggested survival benefits in select patients. Since 2015, our center has been performing an MIS technique using continuous irrigation with aspiration through an endoscope (stereotactic intracerebral underwater blood aspiration [SCUBA]). It is unknown how these patient outcomes compare with intracerebral hemorrhage (ICH) score predictions. Our aim is to determine if SCUBA patients had better 30-day mortality than predicted by their presenting ICH score.
Retrospective review of consecutively admitted patients who underwent SCUBA between December 2015 and March 2019. Operative criteria for MIS evacuation included supratentorial hematoma volume ≥15 mL, age >18, National Institutes of Health Stroke Scale score ≥6, and modified Rankin Scale (mRS) score ≤3. Demographic, radiographic, and clinical data were collected prospectively. The prespecified primary outcome was observed 30-day mortality of SCUBA patients compared with predicted mortality by ICH score on presentation.
One-hundred and fifteen patients underwent SCUBA for hematoma evacuation. Initial mean ICH volume was 51.4 mL (standard deviation 33.9 mL), with a median National Institutes of Health Stroke Scale score of 17 and ICH score of 2. At 1 month, 12 of the 115 SCUBA patients had passed away (30-day mortality rate 10.4%). This was significantly lower than the predicted mortality of 35.1% when calculated using the presenting ICH score (χ (1, N = 115) = 9.5, P < 0.0001), equating to an absolute risk reduction of 24.7%.
This study suggests that minimally invasive hematoma evacuation with the SCUBA technique for ICH may reduce predicted 30-day mortality, with a number needed to treat of 4 to prevent 1 mortality.
最近发表的关于微创血肿清除术（MIS）的文献表明，在某些患者中具有生存获益。自 2015 年以来，我们中心一直在使用一种通过内镜进行连续冲洗和抽吸的 MIS 技术（立体定向颅内水下血液抽吸术 [SCUBA]）。目前尚不清楚这些患者的结果与脑出血（ICH）评分预测值之间的关系。我们的目的是确定 SCUBA 患者的 30 天死亡率是否优于其 ICH 评分预测值。
回顾性分析 2015 年 12 月至 2019 年 3 月期间接受 SCUBA 治疗的连续入院患者。MIS 清除术的手术标准包括幕上血肿体积≥15mL、年龄>18 岁、美国国立卫生研究院卒中量表（NIHSS）评分≥6 分和改良 Rankin 量表（mRS）评分≤3 分。前瞻性收集人口统计学、影像学和临床数据。预设的主要结局是比较 SCUBA 患者的 30 天死亡率与入院时 ICH 评分预测的死亡率。
115 例患者接受 SCUBA 治疗血肿清除术。初始平均 ICH 体积为 51.4mL（标准差 33.9mL），NIHSS 中位数为 17 分，ICH 评分为 2 分。在 1 个月时，115 例 SCUBA 患者中有 12 例死亡（30 天死亡率为 10.4%）。与使用入院时 ICH 评分计算的预测死亡率 35.1%相比，这显著降低（χ(1, N=115)=9.5，P<0.0001），相当于绝对风险降低 24.7%。
这项研究表明，使用 SCUBA 技术进行微创血肿清除术治疗 ICH 可能会降低预测的 30 天死亡率，治疗人数需要 4 人才能预防 1 人死亡。
