Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Neurocrit Care. 2023 Jun;38(3):667-675. doi: 10.1007/s12028-022-01634-9. Epub 2022 Nov 8.
Various surgical methods are available for managing large intracerebral hemorrhage. This study compared the prognosis of patients with spontaneous intracerebral hemorrhage who underwent endoscopic evacuation, stereotactic aspiration, and craniotomy by using a nationwide inpatient database in Japan.
Using the Diagnosis Procedure Combination database, we identified patients who underwent surgery for spontaneous intracerebral hemorrhage within 48 h after admission between April 2014 and March 2018. Eligible patients were classified into three groups according to the type of surgery (endoscopic surgery, stereotactic surgery, and craniotomy). Propensity score matching weight analysis was conducted to compare poor modified Rankin Scale score at discharge (severe disability or death) and hospitalization cost among the groups.
Among 17,860 eligible patients, craniotomy, stereotactic surgery, and endoscopic surgery were performed in 14,354, 474, and 3,032 patients, respectively. In the matching weight analysis, all covariates were well balanced. Compared with the endoscopic surgery group, the proportion of poor prognosis (modified Rankin Scale score at discharge of 5 or 6) was significantly higher in craniotomy groups (odds ratio 2.51, 95% confidence interval 1.11-5.68; p = 0.028). Subgroup analysis based on hemorrhage location and consciousness level at the time of admission showed no significant difference between the surgical procedures. Hospitalization costs were significantly higher in the craniotomy group than in the endoscopic surgery group (difference US $9,724, 95% confidence interval 2,169-17,259; p = 0.011).
Endoscopic surgery for spontaneous intracerebral hemorrhage was associated with improved prognosis compared with craniotomy at the hospital discharge. Future large-scale clinical trials are needed to evaluate the optimal surgical techniques for intracerebral hemorrhage.
对于治疗大型颅内血肿，有多种手术方法可供选择。本研究利用日本全国住院患者数据库，比较了内镜清除术、立体定向抽吸术和开颅术治疗自发性脑出血患者的预后。
我们使用诊断程序组合数据库，确定了 2014 年 4 月至 2018 年 3 月期间入院后 48 小时内接受自发性脑出血手术的患者。根据手术类型（内镜手术、立体定向手术和开颅术）将符合条件的患者分为三组。采用倾向评分匹配权重分析比较三组出院时（严重残疾或死亡）不良改良 Rankin 量表评分和住院费用。
在 17860 名符合条件的患者中，分别有 14354 例、474 例和 3032 例患者接受了开颅术、立体定向手术和内镜手术。在匹配权重分析中，所有协变量均得到很好的平衡。与内镜手术组相比，开颅术组预后不良（出院时改良 Rankin 量表评分为 5 或 6）的比例明显更高（比值比 2.51，95%置信区间 1.11-5.68；p=0.028）。基于入院时出血部位和意识水平的亚组分析显示，手术方法之间无显著差异。开颅术组的住院费用明显高于内镜手术组（差值为 9724 美元，95%置信区间为 2169-17259 美元；p=0.011）。
与开颅术相比，内镜手术治疗自发性脑出血在出院时与改善预后相关。需要进行大规模的临床试验来评估脑出血的最佳手术技术。
