1Department of Neurosurgery, Tangdu Hospital, the Fourth Military Medical University, Xi'an.
6Shaanxi Clinical Research Center for Neurosurgical Diseases, Xi'an, China.
J Neurosurg. 2023 May 19;139(6):1784-1791. doi: 10.3171/2023.4.JNS222910. Print 2023 Dec 1.
Spontaneous basal ganglia hemorrhage is a common type of intracerebral hemorrhage (ICH) with no definitive treatment. Minimally invasive endoscopic evacuation is a promising therapeutic approach for ICH. In this study the authors examined prognostic factors associated with long-term functional dependence (modified Rankin Scale [mRS] score ≥ 4) in patients who had undergone endoscopic evacuation of basal ganglia hemorrhage.
In total, 222 consecutive patients who underwent endoscopic evacuation between July 2019 and April 2022 at four neurosurgical centers were enrolled prospectively. Patients were dichotomized into functionally independent (mRS score ≤ 3) and functionally dependent (mRS score ≥ 4) groups. Hematoma and perihematomal edema (PHE) volumes were calculated using 3D Slicer software. Predictors of functional dependence were assessed using logistic regression models.
Among the enrolled patients, the functional dependence rate was 45.50%. Factors independently associated with long-term functional dependence included female sex, older age (≥ 60 years), Glasgow Coma Scale score ≤ 8, larger preoperative hematoma volume (OR 1.02), and larger postoperative PHE volume (OR 1.03, 95% CI 1.01-1.05). A subsequent analysis evaluated the effect of stratified postoperative PHE volume on functional dependence. Specifically, patients with large (≥ 50 to < 75 ml) and extra-large (≥ 75 to 100 ml) postoperative PHE volumes had 4.61 (95% CI 0.99-21.53) and 6.75 (95% CI 1.20-37.85) times greater likelihood of long-term dependence, respectively, than patients with a small postoperative PHE volume (≥ 10 to < 25 ml).
A large postoperative PHE volume is an independent risk factor for functional dependence among basal ganglia hemorrhage patients after endoscopic evacuation, especially with postoperative PHE volume ≥ 50 ml.
自发性基底节出血是一种常见的脑出血（ICH）类型，目前尚无明确的治疗方法。微创内镜清除术是一种有前途的ICH 治疗方法。本研究旨在探讨内镜清除基底节出血患者长期功能依赖（改良 Rankin 量表[mRS]评分≥4）的相关预后因素。
本研究前瞻性纳入 2019 年 7 月至 2022 年 4 月在 4 家神经外科中心接受内镜清除术的 222 例连续患者。将患者分为功能独立（mRS 评分≤3）和功能依赖（mRS 评分≥4）组。使用 3D Slicer 软件计算血肿和血肿周围水肿（PHE）的体积。使用逻辑回归模型评估功能依赖的预测因素。
在纳入的患者中，功能依赖率为 45.50%。与长期功能依赖相关的独立因素包括女性、年龄较大（≥60 岁）、格拉斯哥昏迷量表评分≤8、术前血肿体积较大（OR 1.02）和术后 PHE 体积较大（OR 1.03，95%CI 1.01-1.05）。随后的分析评估了分层术后 PHE 体积对功能依赖的影响。具体来说，术后 PHE 体积较大（≥50 至＜75ml）和特大（≥75 至 100ml）的患者分别有 4.61（95%CI 0.99-21.53）和 6.75（95%CI 1.20-37.85）倍发生长期依赖的可能性，大于术后 PHE 体积较小的患者（≥10 至＜25ml）。
内镜清除基底节出血后，较大的术后 PHE 体积是患者功能依赖的独立危险因素，尤其是术后 PHE 体积≥50ml。
