Zhang Weihua, Zhang Jian, Huang Gaoming, Yang Kaichuang
Center for Rehabilitation Medicine, Department of Neurosurgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
Department of Neurosurgery, The First People's Hospital of Aksu Region, Aksu, Xinjiang, China.
Transl Neurosci. 2023 Jul 29;14(1):20220292. doi: 10.1515/tnsci-2022-0292. eCollection 2023 Jan 1.
The internal capsule of the basal ganglia is vulnerable to direct pressure from the hematoma and to secondary damage from toxic products of hemorrhage. Our study evaluated the risk and benefits of active strategies including ultra-early surgery and hematoma evacuation through a transsylvian-transinsular approach for moderate basal ganglia hemorrhage.
We retrospectively collected patients with moderate basal ganglia hemorrhage in two hospitals. The conservative group contained 51 patients who had the best medical treatment, and the surgery group contained 36 patients who were treated with hematoma evacuation through a transsylvian-transinsular approach within 6 h from ictus. Motor function of upper and lower limbs recorded with the motor sub-score of NIHSS (m-NIHSS) at the baseline, 7 days, 30 days, and 90 days, the modified Rankin Scale (mRS), and Barthel Index (BI) scores at 30 and 90 days were compared between the two groups. Good recovery was defined as an m-NIHSS of 0-2 and poor recovery as 3-4. Favorable prognosis was defined as an mRS of 0-3 and unfavorable prognosis as 4-5.
The mean time from ictus to surgery was 250.3 ± 57.3 min. The good recovery proportions of upper and lower limbs in the surgery group were significantly higher than that in the conservative group ( < 0.05) at 7 days after hemorrhage. The good recovery proportion of upper limbs was significantly higher in the surgery group than in the conservative group ( < 0.05) at 3 months after hemorrhage. Living ability using BI scores was significantly higher in the surgery group than the conservative group ( < 0.05) at 3 months after hemorrhage. The favorable prognosis proportion had no statistically significant difference between the two groups at 3 months after hemorrhage.
Ultra-early hematoma evacuation through a transsylvian-transinsular approach are active strategies for moderate basal ganglia hemorrhage and have potential advantages in improving motor function recovery and daily living. The postoperative rebleeding rate does not increase simultaneously.
基底节区的内囊易受血肿直接压迫及出血毒性产物的继发性损伤。我们的研究评估了包括超早期手术及经外侧裂-岛叶入路血肿清除术等积极策略治疗中度基底节区出血的风险与益处。
我们回顾性收集了两家医院中度基底节区出血的患者。保守治疗组有51例接受了最佳药物治疗的患者，手术组有36例在发病6小时内接受经外侧裂-岛叶入路血肿清除术治疗的患者。比较两组患者在基线、7天、30天和90天时采用美国国立卫生研究院卒中量表（NIHSS）运动分项评分（m-NIHSS）记录的上下肢运动功能，以及在30天和90天时的改良Rankin量表（mRS）和Barthel指数（BI）评分。良好恢复定义为m-NIHSS为0-2分，恢复不佳定义为3-4分。预后良好定义为mRS为0-3分，预后不良定义为4-5分。
发病至手术的平均时间为250.3±57.3分钟。出血后7天，手术组上下肢良好恢复比例显著高于保守治疗组（P<0.05）。出血后3个月，手术组上肢良好恢复比例显著高于保守治疗组（P<0.05）。出血后3个月，手术组使用BI评分的生活能力显著高于保守治疗组（P<0.05）。出血后3个月，两组预后良好比例无统计学差异。
经外侧裂-岛叶入路超早期血肿清除术是治疗中度基底节区出血的积极策略，在改善运动功能恢复和日常生活方面具有潜在优势。术后再出血率并未同时增加。
