Tang Zhiji, Huang Weilong, Chen Qiqi, Guo Changgui, Zheng Kuan, Wei Wenjin, Jiang Qiuhua, Yang Ruijin
Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, China.
Department of Magnetoencephalography, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China.
Front Neurol. 2024 Feb 26;15:1352949. doi: 10.3389/fneur.2024.1352949. eCollection 2024.
Spontaneous hypertensive brainstem hemorrhage (HBSH) is characterized by sudden onset, rapid progression and poor prognosis. There has been a growing tendency of surgical treatment for HBSH. This study aimed to investigate outcomes and potential factors associated with the prognosis of robot-assisted drainage surgery for HBSH treatment.
Patients with HBSH from July 2016 to March 2023 at a single neurosurgery center were included and divided into conservative group and surgical groups. Baseline and clinical data, radiographic characteristics, complications, and outcome evaluations were recorded and analyzed.
A total of 125 patients, with 74 in the conservative group and 51 in the surgical group, were enrolled in the study. Mortality at 6 months was 59/74 (79.7%) in the conservative group and 9/51 (17.6%) in the surgical group. Twenty-four patients (47.1%) achieved favorable outcomes in the surgical group, whereas this rate in the conservative group was only 5.4% (4/74). There was a significant difference in NIHSS, GCS, and mRS at 6 months between surviving patients in the conservative and surgical groups. In prognostic analysis in the surgical subgroup, initial GCS score [5 (IQR 4-7) vs. 3 (IQR 3-4), < 0.001], NIHSS [36 (IQR 32-38) vs. 40 (IQR 38-40), < 0.001], smoking history [45.8% (11/24) vs. 74.1% (20/27), = 0.039], hematoma volume [6.9 (IQR 6.2-7.6) vs. 9.6 (IQR 7.3-11.4), = 0.001], and hemorrhage location ( = 0.001) were potential risk factors for poor 6-month prognosis after robot-assisted surgery for HBSH.
Based on the results of this study, robot-assisted minimally invasive drainage of brain stem hematoma may significantly reduce mortality and improve prognosis. Surgery should be conducted for selected patients.
自发性高血压脑干出血（HBSH）具有起病急、进展快、预后差的特点。HBSH的手术治疗有增加的趋势。本研究旨在探讨机器人辅助引流手术治疗HBSH的疗效及与预后相关的潜在因素。
纳入2016年7月至2023年3月在单一神经外科中心的HBSH患者，分为保守治疗组和手术治疗组。记录并分析基线和临床资料、影像学特征、并发症及疗效评估。
本研究共纳入125例患者，其中保守治疗组74例，手术治疗组51例。保守治疗组6个月时死亡率为59/74（79.7%），手术治疗组为9/51（17.6%）。手术治疗组24例患者（47.1%）获得良好预后，而保守治疗组这一比例仅为5.4%（4/74）。保守治疗组和手术治疗组存活患者6个月时的美国国立卫生研究院卒中量表（NIHSS）、格拉斯哥昏迷量表（GCS）和改良Rankin量表（mRS）存在显著差异。在手术亚组的预后分析中，初始GCS评分[5（四分位间距4 - 7）对3（四分位间距3 - 4），<0.001]、NIHSS评分[36（四分位间距32 - 38）对40（四分位间距38 - 40），<0.001]、吸烟史[45.8%（11/24）对74.1%（20/27），=0.039]、血肿体积[6.9（四分位间距6.2 - 7.6）对9.6（四分位间距7.3 - 11.4），=0.001]及出血部位（=0.001）是HBSH机器人辅助手术后6个月预后不良的潜在危险因素。
基于本研究结果，机器人辅助微创引流脑干血肿可显著降低死亡率并改善预后。应选择合适的患者进行手术。
