Department of Ultrasound Imaging, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, 443000, Hubei, China.
Department of Neurosurgery, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, 443000, Hubei, China.
Sci Rep. 2024 Sep 3;14(1):20439. doi: 10.1038/s41598-024-71130-x.
To evaluate the efficacy of neuronavigation-assisted stereotactic drilling drainage compared with that of craniotomy in the treatment of massive intracerebral haemorrhage (ICH) in elderly patients. This was a randomized, controlled, blind endpoint clinical study. Elderly patients with massive ICH treated at our neurosurgery department, without the formation of brain herniation preoperatively, all underwent neurosurgical intervention. Patients were randomly assigned to two groups: the minimally invasive surgery (MIS) group, which received neuronavigation-assisted stereotactic drilling drainage, and the craniotomy haematoma removal surgery (CHRS) group. Patient characteristics, surgical anaesthesia methods, surgery duration, intraoperative bleeding volume, duration of ICU stay duration of hospital stay, complications, and modified Rankin scale (mRS) scores at 90 days posttreatment were compared between the two groups. Statistical analysis was performed on the collected data. A total of 67 patients were randomly assigned, with 33 (49.25%) in the MIS group and 34 (50.75%) in the CHRS group. Compared with the CHRS group, the MIS group had advantages, including the use of local anaesthesia, shorter surgery duration, less intraoperative bleeding, shorter ICU stay, and fewer complications (P < 0.05). The MIS group had a significantly improved patient prognosis at 90 days (mRS 0-3). However, there were no significant differences in hospital stay or 90-day survival rate between the two groups (P > 0.05). For elderly patients with massive ICH without brain herniation, stereotactic drilling drainage is a simple surgical procedure that can be performed under local anaesthesia. Patients treated with this approach seem to have better outcomes than those treated with craniotomy. In clinical practice, neuronavigation-assisted stereotactic drilling drainage is recommended for surgical treatment in elderly patients with massive ICH without brain herniation.Clinical trial registration number: NCT04686877.
为了评估神经导航辅助定向钻孔引流术与开颅血肿清除术治疗老年大量脑出血（ICH）的疗效。这是一项随机、对照、盲终点的临床研究。我院神经外科治疗的大量 ICH 老年患者，术前无脑疝形成，均行神经外科干预。患者随机分为两组：微创组（MIS），行神经导航辅助定向钻孔引流术；开颅血肿清除术（CHRS）组。比较两组患者的一般资料、手术麻醉方法、手术时间、术中出血量、重症监护病房停留时间、住院时间、并发症及治疗后 90 天改良 Rankin 量表（mRS）评分。对收集的数据进行统计学分析。共随机分配 67 例患者，MIS 组 33 例（49.25%），CHRS 组 34 例（50.75%）。与 CHRS 组相比，MIS 组具有以下优点：局部麻醉、手术时间短、术中出血量少、入住重症监护病房时间短、并发症少（P < 0.05）。MIS 组患者预后在 90 天时明显改善（mRS 0-3）。但两组患者的住院时间或 90 天生存率无差异（P > 0.05）。对于无脑疝的老年大量 ICH 患者，定向钻孔引流术是一种简单的手术方法，可以在局部麻醉下进行。接受这种治疗的患者似乎比接受开颅手术的患者预后更好。在临床实践中，对于无脑疝的老年大量 ICH 患者，建议采用神经导航辅助定向钻孔引流术进行手术治疗。临床试验注册号：NCT04686877。
