Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan; Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
J Stroke Cerebrovasc Dis. 2022 Sep;31(9):106664. doi: 10.1016/j.jstrokecerebrovasdis.2022.106664. Epub 2022 Jul 28.
Minimally invasive surgery for spontaneous intracerebral hemorrhage (ICH) has become increasingly popular in recent years. However, there are no reports on the recent trends in surgical procedures for spontaneous ICH. To investigate current trends in surgical methods for spontaneous ICH using a nationwide inpatient database from Japan.
Patients who underwent surgery for spontaneous ICH between April 2014 and March 2018 were identified in a nationwide inpatient database from Japan. We examined patient characteristics, diagnoses, types of surgery, complications, and discharge status.
We identified 21,129 inpatients who underwent surgery for spontaneous ICH. The procedures were as follows: 16,256 (76.9%) transcranial hemorrhage evacuations, 3722 (17.6%) endoscopic hemorrhage evacuations, and 1151 (5.4%) stereotactic aspirations of hemorrhage. Patients tended to receive transcranial hemorrhage evacuations in hospitals with fewer surgical cases. The proportions of endoscopic hemorrhage evacuations increased annually, whereas those of stereotactic surgery decreased. The proportions of transcranial surgery remained almost unchanged. Tracheostomy and hospitalization costs were lower in the stereotactic aspirations of hemorrhage group, and the proportions of reoperation were higher in the endoscopic hemorrhage evacuations group.
The use of endoscopic surgery for spontaneous ICH has increased in Japan. This study can form the basis of future clinical investigations into spontaneous ICH surgery.
微创治疗自发性脑出血（ICH）近年来越来越受到关注。然而，目前尚无关于自发性 ICH 手术治疗方法最新趋势的报道。本研究旨在使用日本全国住院患者数据库调查自发性 ICH 手术方法的最新趋势。
在日本全国住院患者数据库中，检索 2014 年 4 月至 2018 年 3 月期间接受自发性 ICH 手术治疗的患者。我们检查了患者的特征、诊断、手术类型、并发症和出院情况。
共纳入 21129 例接受自发性 ICH 手术的患者。手术方式如下：开颅血肿清除术 16256 例（76.9%），内镜血肿清除术 3722 例（17.6%），立体定向血肿抽吸术 1151 例（5.4%）。在手术例数较少的医院，患者更倾向于接受开颅血肿清除术。内镜血肿清除术的比例逐年增加，而立体定向手术的比例则逐渐减少。开颅手术的比例基本保持不变。立体定向血肿抽吸术组的气管切开和住院费用较低，内镜血肿清除术组的再次手术比例较高。
日本采用内镜手术治疗自发性 ICH 的比例有所增加。本研究可为自发性 ICH 手术的未来临床研究奠定基础。
