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54 例颅内血肿(ICH)的急性清除术在破裂大脑中动脉分叉部动脉瘤夹闭术中-连续脑 CT/MRI 面板的个体临床病程和结果说明,直至 12 个月。

Acute evacuation of 54 intracerebral hematomas (aICH) during the microsurgical clipping of a ruptured middle cerebral artery bifurcation aneurysm-illustration of the individual clinical courses and outcomes with a serial brain CT/MRI panel until 12 months.

机构信息

Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland.

Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.

出版信息

Acta Neurochir (Wien). 2024 Jan 17;166(1):17. doi: 10.1007/s00701-024-05902-9.


DOI:10.1007/s00701-024-05902-9
PMID:38231317
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10794262/
Abstract

PURPOSE: In aneurysmal intracerebral hemorrhage (aICH), our review showed the lack of the patient's individual (i) timeline panels and (ii) serial brain CT/MRI slice panels through the aICH evacuation and neurointensive care until the final brain tissue outcome. METHODS: Our retrospective cohort consists of 54 consecutive aICH patients from a defined population who acutely underwent the clipping of a middle cerebral artery bifurcation saccular aneurysm (Mbif sIA) with the aICH evacuation at Kuopio University Hospital (KUH) from 2010 to 2019. We constructed the patient's individual timeline panels since the emergency call and serial brain CT/MRI slice panels through the aICH evacuation and neurointensive care until the final brain tissue outcome. The patients were indicated by numbers (1.-54.) in the pseudonymized panels, tables, results, and discussion. RESULTS: The aICH volumes on KUH admission (median 46 cm) plotted against the time from the emergency call to the evacuation (median 8 hours) associated significantly with the rebleeds (n=25) and the deaths (n=12). The serial CT/MRI slice panels illustrated the aICHs, intraventricular hemorrhages (aIVHs), residuals after the aICH evacuations, perihematomal edema (PHE), delayed cerebral injury (DCI), and in the 42 survivors, the clinical outcome (mRS) and the brain tissue outcome. CONCLUSIONS: Regarding aICH evacuations, serial brain CT/MRI panels present more information than words, figures, and graphs. Re-bleeds associated with larger aICH volumes and worse outcomes. Swift logistics until the sIA occlusion with aICH evacuation is required, also in duty hours and weekends. Intraoperative CT is needed to illustrate the degree of aICH evacuation. PHE may evoke uncontrollable intracranial pressure (ICP) in spite of the acute aICH volume reduction.

摘要

目的:在颅内动脉瘤性脑出血(aICH)中,我们的研究显示,缺乏患者个体(i)时间线面板和(ii)通过 aICH 清除和神经重症监护直到最终脑组织结局的连续脑 CT/MRI 切片面板。

方法:我们的回顾性队列包括 2010 年至 2019 年期间在库奥皮奥大学医院(KUH)急性接受大脑中动脉分叉部囊状动脉瘤夹闭(Mbif sIA)和 aICH 清除的 54 例连续 aICH 患者。我们构建了患者自急救电话以来的个体时间线面板和通过 aICH 清除和神经重症监护的连续脑 CT/MRI 切片面板,直到最终脑组织结局。患者在匿名面板、表格、结果和讨论中用数字(1.-54.)表示。

结果:KUH 入院时的 aICH 体积(中位数 46cm³)与从急救电话到清除的时间(中位数 8 小时)相关,与再出血(n=25)和死亡(n=12)显著相关。连续的 CT/MRI 切片面板显示了 aICH、脑室内出血(aIVH)、aICH 清除后的残留物、血肿周围水肿(PHE)、迟发性脑损伤(DCI),以及在 42 名幸存者中,临床结局(mRS)和脑组织结局。

结论:关于 aICH 清除,连续的脑 CT/MRI 面板提供的信息比文字、数字和图表更多。再出血与更大的 aICH 体积和更差的结局相关。需要迅速的物流流程,直到 sIA 闭塞和 aICH 清除,即使在值班时间和周末也是如此。需要术中 CT 来说明 aICH 清除的程度。尽管急性 aICH 体积减少,但 PHE 可能会引起不可控的颅内压(ICP)。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2551/10794262/4f3917e0f704/701_2024_5902_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2551/10794262/a476725968b8/701_2024_5902_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2551/10794262/d5aaeb498cef/701_2024_5902_Fig2a_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2551/10794262/c550c30a0b9a/701_2024_5902_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2551/10794262/4f3917e0f704/701_2024_5902_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2551/10794262/a476725968b8/701_2024_5902_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2551/10794262/d5aaeb498cef/701_2024_5902_Fig2a_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2551/10794262/c550c30a0b9a/701_2024_5902_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2551/10794262/4f3917e0f704/701_2024_5902_Fig4_HTML.jpg

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