Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
J Neurointerv Surg. 2024 Sep 17;16(10):994-1004. doi: 10.1136/jnis-2023-020787.
We explored the clinical significance of the residual hematoma cavity 1 year after minimally invasive intracerebral hemorrhage (ICH) evacuation.
Patients presenting with spontaneous supratentorial ICH were evaluated for minimally invasive surgical evacuation. Inclusion criteria included age ≥18 years, preoperative hematoma volume (Hv) ≥15 mL, presenting National Institutes of Health Stroke Scale score ≥6, and premorbid modified Rankin Scale (mRS) score ≤3. Patients with longitudinal CT scans at least 3 months after evacuation were included in the study. Remnant cavity volumes (Cv) after evacuation were computed using semi-automatic volumetric segmentation software. Relative cavity volume (rCv) was defined as the ratio of the preoperative Hv to the remnant Cv.
108 patients with a total of 484 head CT scans were included in the study. The median postoperative Cv was 2.4 (IQR 0.0-11) mL, or just 6% (0-33%) of the preoperative Hv. The median residual Cv on the final head CT scan a median of 13 months (range 11-27 months) after surgery had increased to 9.4 (IQR 3.1-18) mL, or 25% (10-60%) of the preoperative Hv. rCv on the final head CT scan was negatively associated with measures of operative success including evacuation percentage, postoperative Hv ≤15 mL, and decreased time from ictus to evacuation. rCv on the final head CT scan was also associated with a worse 6-month functional outcome (β per mRS point 17.6%, P<0.0001; area under the receiver operating characteristic curve 0.91).
After minimally invasive ICH evacuation the hematoma lesion decompresses significantly, with a residual Cv just 6% of the original lesion, but then gradually increases in size over time. Early and high percentage ICH evacuation may reduce the remnant Cv over time which, in turn, is associated with improved functional outcomes.
我们探讨了微创脑出血（ICH）清除术后 1 年残余血肿腔的临床意义。
对接受微创脑出血清除术的自发性幕上ICH 患者进行评估。纳入标准包括年龄≥18 岁、术前血肿量（Hv）≥15mL、美国国立卫生研究院卒中量表（NIHSS）评分≥6 分、发病前改良 Rankin 量表（mRS）评分≤3 分。术后至少 3 个月行头颅 CT 扫描的患者纳入研究。采用半自动容积分割软件计算术后残余血肿腔体积（Cv）。术后残余血肿腔体积与术前血肿量的比值定义为相对残余血肿腔体积（rCv）。
共纳入 108 例患者，共计 484 个头 CT 扫描。术后 Cv 的中位数为 2.4mL（IQR 0.0-11），仅为术前 Hv 的 6%（0-33%）。术后 13 个月（11-27 个月）的最终头颅 CT 扫描显示，残余 Cv 的中位数增加至 9.4mL（IQR 3.1-18），为术前 Hv 的 25%（10-60%）。最终头颅 CT 扫描的 rCv 与手术成功率的各项指标呈负相关，包括清除百分比、术后 Hv≤15mL 以及从发病到清除的时间缩短。最终头颅 CT 扫描的 rCv 也与 6 个月时的功能结局较差相关（mRS 评分每增加 1 分，β为 17.6%，P<0.0001；受试者工作特征曲线下面积为 0.91）。
微创脑出血清除术后血肿病变明显减压，残余血肿腔仅为原始病变的 6%，但随着时间的推移逐渐增大。早期和高比例 ICH 清除可能会随时间减少残余 Cv，进而改善功能结局。
