Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Neurosurgery, Taikang Tongji (Wuhan) Hospital, Wuhan, China.
Neurosurg Rev. 2023 Sep 21;46(1):254. doi: 10.1007/s10143-023-02161-7.
The purpose of this study was to evaluate and summarize the technical characteristics and clinical efficacy of using Dyna-computed tomography (CT)-assisted neuroendoscopic hematoma evacuation to treat hypertensive intracerebral hemorrhage (HICH). We treated 42 consecutive patients with HICH who underwent neuroendoscopic hematoma evacuation in our department from March 1, 2020, to May 31, 2022. Patients were divided into two groups: Dyna-CT-assisted neuroendoscopic group (n = 18) and neuroendoscopic group (n = 24). Retrospective data, treatment efficacy, and outcomes were collected and compared between these two groups. The operative time in the Dyna-CT-assisted neuroendoscopic group was significantly shorter than the operative time in the neuroendoscopic group (mean time 131.6 ± 13.51 vs. 156.6 ± 19.25 min, P < 0.001). Dyna-CT-assisted neuroendoscopic group had significantly less intraoperative blood loss than the neuroendoscopic group (46.94 ± 10.42 vs. 106.46 ± 23.25, P = 0.003). Meanwhile, patients who underwent Dyna-CT-assisted neuroendoscopic had a comparable hematoma clearance rate to those who underwent neuroendoscopic (89.36 ± 7.31 vs. 68.87 ± 19.44%, P = 0.006). The incidence of complications in the Dyna-CT-assisted neuroendoscopic group (5.5%) was lower than in the neuroendoscopic group (12.5%), but the difference was not statistically significant (P = 0.129). Patients who underwent Dyna-CT-assisted neuroendoscopic hematoma evacuation had better 6-month functional outcomes, and the difference was significant (P = 0.004). Furthermore, multivariable analysis showed that younger age, smaller hematoma volume, and Dyna-CT-assisted neuroendoscopic were predictors of favorable 6-month outcomes in HICH patients. In the treatment of HICH, Dyna-CT-assisted hematoma evacuation appears to be safer and more effective than neuroendoscopic hematoma evacuation. Dyna-CT-assisted neuroendoscopic hematoma evacuation in hybrid operating rooms may improve the clinical effect and outcomes of patients with HICH.
本研究旨在评估和总结使用 Dyna 计算机断层扫描（CT）辅助神经内镜血肿清除术治疗高血压性脑出血（HICH）的技术特点和临床疗效。我们对 2020 年 3 月 1 日至 2022 年 5 月 31 日在我科接受神经内镜血肿清除术的 42 例 HICH 患者进行了治疗。患者分为两组：Dyna-CT 辅助神经内镜组（n=18）和神经内镜组（n=24）。收集并比较了两组患者的回顾性资料、治疗效果和预后。Dyna-CT 辅助神经内镜组的手术时间明显短于神经内镜组（平均时间 131.6±13.51 分钟比 156.6±19.25 分钟，P<0.001）。Dyna-CT 辅助神经内镜组术中出血量明显少于神经内镜组（46.94±10.42 毫升比 106.46±23.25 毫升，P=0.003）。同时，Dyna-CT 辅助神经内镜组的血肿清除率与神经内镜组相当（89.36±7.31%比 68.87±19.44%，P=0.006）。Dyna-CT 辅助神经内镜组（5.5%）的并发症发生率低于神经内镜组（12.5%），但差异无统计学意义（P=0.129）。接受 Dyna-CT 辅助神经内镜血肿清除术的患者 6 个月后的功能预后更好，差异有统计学意义（P=0.004）。此外，多变量分析显示，年龄较小、血肿体积较小和 Dyna-CT 辅助神经内镜是 HICH 患者 6 个月预后良好的预测因素。在 HICH 的治疗中，Dyna-CT 辅助血肿清除术似乎比神经内镜血肿清除术更安全、更有效。杂交手术室中 Dyna-CT 辅助神经内镜血肿清除术可能改善 HICH 患者的临床效果和预后。
