Yang Feilong, Xu Wuhuan, Tang Xielin, Yang Yan, Ku Buqian A, Zhang Yiping, Yang Xiaoli, Xie Wei, Hui Xuhui
Department of Neurosurgery, Santai Hospital Affiliated to North Sichuan Medical College, Mian Yang, Sichuan, China.
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Front Surg. 2024 Oct 28;11:1472830. doi: 10.3389/fsurg.2024.1472830. eCollection 2024.
Neuroendoscopic surgery (NES) has been proven to be safe and effective in hematoma evacuation for cerebral hemorrhage. However, its efficacy for thalamic hemorrhage accompanied by intraventricular hematoma (THAVH) remains unclear. The aim of this study is to determine the efficacy of NES in treating THAVH.
A retrospective study was carried out. The data of patients diagnosed with THAVH were collected from January 1st, 2019, to January 1st, 2022. Patients received the NES or external ventricle drainage (EVD) treatment were assigned to the NES or EVD group, respectively. As primary outcomes, the hematoma evacuation volume, residual hematoma volume, and hematoma clearance rate were separately calculated based on the hematoma site; and the 180-day-mRS score was assessed. As secondary outcomes, the length of stay in the ICU and hospital, and the adverse events were also compared.
Thirty-five patients, aged 66.37 ± 6.62 years, were in the NES group; and 40 patients, aged 68.75 ± 7.22 years, were in the EVD group. The baseline characteristics in the two groups were similar ( > 0.05). The gross hematoma evacuation volume, volume of hematoma evacuated in the thalamus or the ventricle, and the hematoma clearance rate were greater in the NES group than in the EVD group on the 1st day after surgery ( < 0.05). The patients had a better rank of mRS in the NES group ( < 0.05). Compared with patients with mRS > 3, the mean residual hematoma volume in the thalamus of patients with mRS ≤3 on the 1st and 7th day were less in each group ( < 0.05), respectively. A residual hematoma volume in the ventricle of patients with mRS ≤3 was less than that of patients with mRS >3 in the EVD group on the 1st day after surgery ( < 0.05). GCS score on the 3rd day was greater in the NES group ( < 0.05). The incidence of lung infection was lower in the NES group ( < 0.05). The length of stay in the ICU and hospitalization duration were shorter in the NES group ( < 0.05).
Neuroendoscopic surgery has a greater hematoma clearance rate, a lower lung infection rate and a shorter duration in the hospital. Neuroendoscopic surgery might improve patients' prognosis. Neuroendoscopic surgery is a safe and effective procedure for treating thalamic hemorrhage accompanied by intraventricular hematoma.
神经内镜手术（NES）已被证明在脑出血血肿清除方面是安全有效的。然而，其对伴有脑室内血肿的丘脑出血（THAVH）的疗效仍不明确。本研究的目的是确定NES治疗THAVH的疗效。
进行一项回顾性研究。收集2019年1月1日至2022年1月1日诊断为THAVH的患者数据。接受NES或脑室外引流（EVD）治疗的患者分别被分配到NES组或EVD组。作为主要结局指标，根据血肿部位分别计算血肿清除体积、残余血肿体积和血肿清除率；并评估180天改良Rankin量表（mRS）评分。作为次要结局指标，还比较了重症监护病房（ICU）和医院的住院时间以及不良事件。
NES组有35例患者，年龄为66.37±6.62岁；EVD组有40例患者，年龄为68.75±7.22岁。两组的基线特征相似（P>0.05）。术后第1天，NES组的血肿清除总体积、丘脑或脑室内清除的血肿体积以及血肿清除率均高于EVD组（P<0.05）。NES组患者的mRS分级更好（P<0.05）。与mRS>3的患者相比，每组中mRS≤3的患者在第1天和第7天丘脑的平均残余血肿体积分别较小（P<0.05）。术后第1天，EVD组中mRS≤3的患者脑室内残余血肿体积小于mRS>3的患者（P<0.05）。NES组第3天的格拉斯哥昏迷量表（GCS）评分更高（P<0.05）。NES组肺部感染的发生率较低（P<0.05）。NES组在ICU的住院时间和住院总时长较短（P<0.05）。
神经内镜手术具有更高的血肿清除率、更低的肺部感染率和更短的住院时间。神经内镜手术可能改善患者的预后。神经内镜手术是治疗伴有脑室内血肿的丘脑出血的一种安全有效的方法。
