Wang Ning, Lin Weiwei, Zhu Xuanhao, Tu Qi, Zhu Daqian, Qu Shuai, Yang Jianjing, Ruan Linhui, Zhuge Qichuan
Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, China.
Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
Chin Neurosurg J. 2022 Aug 19;8(1):26. doi: 10.1186/s41016-022-00288-y.
The treatment for spontaneous intracerebral hemorrhage (ICH) is still controversial, especially for hematomas in the basal ganglia. A retrospective case-control study with propensity score matching was performed to compare the outcomes of conventional craniotomy and conservative treatment for patients with minor ICH in the basal ganglia.
We retrospectively collected the data of consecutive patients with minor basal ganglia hemorrhage from January 2018 to August 2019. We compared clinical outcomes of two groups using propensity score matching. The extended Glasgow outcome scale obtained by phone interviews based on questionnaires at a 12-month follow-up was used as the primary outcome measure. According to a previous prognosis algorithm, patients were divided into good and poor prognosis groups to obtain a dichotomized (favorable or unfavorable) outcome as the primary outcome. Secondary outcomes included hospitalized complications, mortality, and modified Rankin score at 12 months.
A total of 54 patients were analyzed, and the baseline characteristics of patients in the surgery and conservative treatment groups were well matched. The primary favorable outcome at 12 months was significantly higher in the conservative treatment group than in the surgery group (81% vs 44%; OR 1.833, 95% CI 1.159-2.900; P=0.005). The incidence of pneumonia in the surgery group was significantly higher than that in the conservative treatment group (P=0.005).
It is not recommended to undertake conventional craniotomy for patients with a minor hematoma (25-40 ml) in the basal ganglia. An open craniotomy might induce worse long-term functional outcomes than the conservative treatment.
自发性脑出血（ICH）的治疗仍存在争议，尤其是基底节区血肿。进行了一项倾向评分匹配的回顾性病例对照研究，以比较基底节区轻度ICH患者常规开颅手术和保守治疗的效果。
我们回顾性收集了2018年1月至2019年8月连续的基底节区轻度出血患者的数据。我们使用倾向评分匹配比较两组的临床结果。以12个月随访时基于问卷通过电话访谈获得的扩展格拉斯哥预后量表作为主要结局指标。根据先前的预后算法，将患者分为预后良好和预后不良组，以获得二分法（有利或不利）结局作为主要结局。次要结局包括住院并发症、死亡率和12个月时的改良Rankin评分。
共分析了54例患者，手术组和保守治疗组患者的基线特征匹配良好。保守治疗组12个月时的主要有利结局显著高于手术组（81%对44%；OR 1.833，95%CI 1.159-2.900；P=0.005）。手术组肺炎发生率显著高于保守治疗组（P=0.005）。
不建议对基底节区小血肿（25-40 ml）患者进行常规开颅手术。与保守治疗相比，开颅手术可能导致更差的长期功能结局。
