Department of Neurosurgery, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, 441000, Hubei province, China.
Department of Ophthalmology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, 441000, Hubei province, China.
Chin J Traumatol. 2024 Dec;27(6):340-347. doi: 10.1016/j.cjtee.2024.03.006. Epub 2024 Mar 16.
Although traditional craniotomy (TC) surgery has failed to show benefits for the functional outcome of intracerebral hemorrhage (ICH). However, a minimally invasive hematoma removal plan to avoid white matter fiber damage may be a safer and more feasible surgical approach, which may improve the prognosis of ICH. We conducted a historical cohort study on the use of multimodal image fusion-assisted neuroendoscopic surgery (MINS) for the treatment of ICH, and compared its safety and effectiveness with traditional methods.
This is a historical cohort study involving 241 patients with cerebral hemorrhage. Divided into MINS group and TC group based on surgical methods. Multimodal images (CT skull, CT angiography, and white matter fiber of MRI diffusion-tensor imaging) were fused into 3 dimensional images for preoperative planning and intraoperative guidance of endoscopic hematoma removal in the MINS group. Clinical features, operative efficiency, perioperative complications, and prognoses between 2 groups were compared. Normally distributed data were analyzed using t-test of 2 independent samples, Non-normally distributed data were compared using the Kruskal-Wallis test. Meanwhile categorical data were analyzed via the Chi-square test or Fisher's exact test. All statistical tests were two-sided, and p < 0.05 was considered statistically significant.
A total of 42 patients with ICH were enrolled, who underwent TC surgery or MINS. Patients who underwent MINS had shorter operative time (p < 0.001), less blood loss (p < 0.001), better hematoma evacuation (p = 0.003), and a shorter stay in the intensive care unit (p = 0.002) than patients who underwent TC. Based on clinical characteristics and analysis of perioperative complications, there is no significant difference between the 2 surgical methods. Modified Rankin scale scores at 180 days were better in the MINS than in the TC group (p = 0.014).
Compared with TC for the treatment of ICH, MINS is safer and more efficient in cleaning ICH, which improved the prognosis of the patients. In the future, a larger sample size clinical trial will be needed to evaluate its efficacy.
尽管传统开颅术（TC）未能显示出对脑出血（ICH）功能结果的益处。然而，一种微创血肿清除计划，以避免白质纤维损伤，可能是一种更安全、更可行的手术方法，可能改善 ICH 的预后。我们对使用多模态图像融合辅助神经内镜手术（MINS）治疗 ICH 进行了历史队列研究，并将其安全性和有效性与传统方法进行了比较。
这是一项历史队列研究，涉及 241 例脑出血患者。根据手术方法分为 MINS 组和 TC 组。多模态图像（CT 颅骨、CT 血管造影和 MRI 扩散张量成像的白质纤维）融合成 3 维图像，用于 MINS 组内镜血肿清除的术前规划和术中引导。比较两组的临床特征、手术效率、围手术期并发症和预后。正态分布数据采用两独立样本 t 检验进行分析，非正态分布数据采用 Kruskal-Wallis 检验进行比较。同时，分类数据采用卡方检验或 Fisher 精确检验进行分析。所有统计检验均为双侧检验，p<0.05 为统计学显著差异。
共纳入 42 例 ICH 患者，行 TC 手术或 MINS 手术。与 TC 组相比，MINS 组手术时间更短（p<0.001），出血量更少（p<0.001），血肿清除效果更好（p=0.003），重症监护病房停留时间更短（p=0.002）。基于临床特征和围手术期并发症分析，两种手术方法无显著差异。MINS 组 180 天改良 Rankin 量表评分优于 TC 组（p=0.014）。
与 TC 治疗 ICH 相比，MINS 更安全、更高效地清除 ICH，改善了患者的预后。未来需要更大样本量的临床试验来评估其疗效。
