Department of neurosurgery, Hospital of Chengdu University of Traditional Chinese.
J Stroke Cerebrovasc Dis. 2023 Aug;32(8):107192. doi: 10.1016/j.jstrokecerebrovasdis.2023.107192. Epub 2023 May 20.
Decreased organ function and poor physical compensatory capacity in elderly patients diagnosed with spontaneous intracerebral hemorrhage (ICH) can make surgical treatment procedures challenging and risky. Minimally invasive puncture drainage (MIPD) combined with urokinase infusion therapy is a safe and feasible method of treating ICH. This study aimed to compare the treatment efficacy of MIPD conducted under local anesthesia using either 3DSlicer + Sina application or computer tomography (CT)-guided stereotactic localization of hematomas in elderly patients diagnosed with ICH.
The study sample included 78 elderly patients (≥ 65 years of age) diagnosed with ICH for the first time. All patients exhibited stable vital signs and underwent surgical treatment. The study sample was randomly divided into two groups, either receiving 3DSlicer+Sina or CT-guided stereotactic assistance. The preoperative preparation time; hematoma localization accuracy rate; satisfactory hematoma puncture rate; hematoma clearance rate; postoperative rebleeding rate; Glasgow Coma Scale (GCS) score after 7 days; and modified Rankin scale (mRS) score 6 months after surgery were compared between the two groups.
No significant differences in gender, age, preoperative GCS score, preoperative hematoma volume (HV), and surgical duration were observed between the two groups (all p-values > 0.05). However, the preoperative preparation time was shorter in the group receiving 3DSlicer + Sina assistance compared to that receiving CT-guided stereotactic assistance (p-value < 0.001). Both groups exhibited significant improvement in GCS scores and reduction in HV after surgery (all p-values < 0.001). The accuracy of hematoma localization and puncture was 100% in both groups. There were no significant differences in surgical duration, postoperative hematoma clearance rate, rebleeding rate, postoperative GCS and mRS scores between the two groups (all p-values > 0.05).
A combination of 3DSlicer and Sina is effective in accurately identifying hematomas in elderly patients with ICH exhibiting stable vital signs, thus simplifying MIPD surgeries conducted under local anesthesia. This procedure may also be preferred over CT-guided stereotactic localization in clinical practice due to its ease of use and accuracy in hematoma localization.
患有自发性脑出血（ICH）的老年患者器官功能下降，身体代偿能力差，使手术治疗具有挑战性和风险。微创穿刺引流（MIPD）联合尿激酶灌注治疗是一种安全可行的治疗 ICH 的方法。本研究旨在比较局部麻醉下使用 3DSlicer+Sina 应用或计算机断层扫描（CT）引导血肿立体定向定位治疗老年 ICH 患者的疗效。
本研究样本包括 78 名首次诊断为 ICH 的老年患者（≥65 岁）。所有患者生命体征稳定，均接受手术治疗。研究样本随机分为两组，分别接受 3DSlicer+Sina 或 CT 引导立体定向辅助。比较两组患者术前准备时间；血肿定位准确率；满意血肿穿刺率；血肿清除率；术后再出血率；术后 7 天格拉斯哥昏迷评分（GCS）；术后 6 个月改良 Rankin 量表（mRS）评分。
两组患者性别、年龄、术前 GCS 评分、术前血肿量（HV）和手术时间比较，差异均无统计学意义（均 P 值>0.05）。但接受 3DSlicer+Sina 辅助组术前准备时间短于接受 CT 引导立体定向辅助组（P 值<0.001）。两组术后 GCS 评分均显著升高，HV 均显著降低（均 P 值<0.001）。两组血肿定位和穿刺准确率均为 100%。两组手术时间、术后血肿清除率、再出血率、术后 GCS 和 mRS 评分比较，差异均无统计学意义（均 P 值>0.05）。
3DSlicer 联合 Sina 可有效准确识别生命体征稳定的老年 ICH 患者的血肿，从而简化局部麻醉下的 MIPD 手术。与 CT 引导立体定向定位相比，该方法在临床实践中因其操作简单、血肿定位准确而更受青睐。
