Jiangsu College of Nursing, No. 9 Keji Avenue, Huai'an 223002, Jiangsu, China.
Department of Neurology, Huai'an First People's Hospital, the Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, No. 1 Huanghe West Road, Huai'an 223300, Jiangsu, China.
J Clin Neurosci. 2024 Oct;128:110743. doi: 10.1016/j.jocn.2024.07.004. Epub 2024 Aug 12.
This study aimed to compare the efficacy of computed tomography (CT)-guided minimally invasive puncture and drainage (MIPD) and craniotomy for hematoma evacuation in the treatment of cerebellar hemorrhage.
This single-center prospective cohort study was conducted from January 2020 to February 2023. During the study period, 40 patients with cerebellar hemorrhage who underwent CT-guided MIPD treatment were enrolled in the CT-guided MIPD (CTGMIPD) group, and 40 patients with the cerebellar hemorrhage who had a propensity score matching that of the CTGMIPD group and who underwent craniotomy for hematoma evacuation were enrolled in the standard craniotomy (SC) group. The primary outcome indicators were the 6-month mortality of the patients and the proportion of survivors with a modified Rankin Scale (mRS) scores of 1 or 2. The secondary outcome indicators were the cerebellar hematoma volume, National Institutes of Health Stroke Scale (NIHSS) score, Glasgow Coma Scale (GCS) score, incidence of postoperative complications, length of hospital stay, and medical costs. In addition, data concerning the patients who died during the study period were further analyzed.
At the 6-month follow-up, there was no significant difference in mortality between the two groups, although the proportion of patients with an mRS scores of 1 or 2 was significantly higher in the CTGMIPD group when compared with the SC group (P = 0.015). No significant differences were observed in the hematoma volume, NIHSS score, and GCS score between the two groups. By contrast, the incidence of postoperative complications, length of hospital stay, and medical costs were significantly lower in the CTGMIPD group than in the SC group (all P < 0.05). When compared with the SC group, the proportion of dead patients with a hematoma volume greater than 30 ml was higher in the CTGMIPD group (P = 0.03). Moreover, after stratification of the patients with a preoperative GCS score ≤8, the CTGMIPD group had a significantly higher mortality rate than the SC group (P = 0.04).
The efficacy of CT-guided MIPD in the treatment of cerebellar hemorrhage is close to that of craniotomy for hematoma excavation, although the complication and disability rates of the former are significantly lower than those of the latter. When the preoperative hematoma volume is less than 30 mL or the preoperative GCS score is greater than 8, CT-guided MIPD represents a better choice for the treatment of cerebellar hemorrhage than craniotomy for hematoma evacuation.
本研究旨在比较 CT 引导下微创穿刺抽吸术（MIPD）与开颅血肿清除术治疗小脑血肿的疗效。
这是一项单中心前瞻性队列研究，于 2020 年 1 月至 2023 年 2 月进行。研究期间，共纳入 40 例接受 CT 引导下 MIPD 治疗的小脑血肿患者，作为 CT 引导下 MIPD（CTGMIPD）组，另选取 40 例经倾向性评分匹配 CTGMIPD 组且接受开颅血肿清除术的小脑血肿患者作为标准开颅（SC）组。主要结局指标为患者 6 个月死亡率和改良 Rankin 量表（mRS）评分 1 或 2 分的幸存者比例。次要结局指标为小脑血肿量、美国国立卫生研究院卒中量表（NIHSS）评分、格拉斯哥昏迷量表（GCS）评分、术后并发症发生率、住院时间和医疗费用。此外，对研究期间死亡的患者进行了进一步分析。
6 个月随访时，两组死亡率无显著差异，但 CTGMIPD 组 mRS 评分 1 或 2 分的患者比例显著高于 SC 组（P=0.015）。两组血肿量、NIHSS 评分和 GCS 评分无显著差异。相比之下，CTGMIPD 组术后并发症发生率、住院时间和医疗费用均显著低于 SC 组（均 P<0.05）。与 SC 组相比，CTGMIPD 组血肿量大于 30ml 的死亡患者比例更高（P=0.03）。此外，对术前 GCS 评分≤8 的患者进行分层后，CTGMIPD 组死亡率显著高于 SC 组（P=0.04）。
CT 引导下 MIPD 治疗小脑血肿的疗效与开颅血肿清除术相当，但前者的并发症和残疾率明显低于后者。当术前血肿量小于 30ml 或术前 GCS 评分大于 8 时，与开颅血肿清除术相比，CT 引导下 MIPD 是治疗小脑血肿的更好选择。
