Wang Mingze, Ge Peicong, Jiao Yuming, Deng Xiaofeng, Yu Songlin, Jiang Yuha, Li Zhi, Wang Tao, He Hongwei, Li Youxiang, Chen Xiaolin, Wang Shuo, Cao Yong
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China.
Chin Neurosurg J. 2024 Dec 16;10(1):33. doi: 10.1186/s41016-024-00385-0.
Precise diagnosis and rapid treatment for acute complex intracranial hemorrhage (ICH) are crucial. The neurosurgical hybrid operating platform integrates traditional open neurosurgery operating room functionalities with endovascular therapy capabilities and is developing in the neurosurgical practice. However, its effect on the emergent complicated neurovascular cases needs pilot exploration.
In this prospective study, a total of 103 cases of both spontaneous and non-spontaneous ICH were consecutively recruited between June 2019 and June 2023. Demographic data, including age, gender distribution, and types of hemorrhage, were collected. Surgical interventions were tailored based on DSA, including spontaneous and non-spontaneous hemorrhages. Functional outcomes were assessed using the modified Rankin Scale (mRS) preoperatively and postoperatively.
Over the study period from June 2019 to June 2023, a cohort of 103 ICH cases underwent emergency hybrid surgical treatment utilizing the E-HOPE platform. Among these cases, 88 were classified as spontaneous ICH, while 15 were non-spontaneous. The mean age at diagnosis for the entire cohort was 54.0 ± 3.7 years, with a slight predominance of male patients. Spontaneous ICH encompassed a diverse spectrum of etiologies, including arteriovenous malformations, aneurysms, arteriovenous fistulas, cavernous malformations, moyamoya disease, and cryptogenic hemorrhages. Surgical interventions were tailored to address the specific pathology. Notably, improvements in mRS scores were observed in a majority of cases, with some patients experiencing stabilization or deterioration postoperatively. Non-spontaneous cases (n = 15) were primarily iatrogenic (n = 13) due to tumors adjacent to the internal carotid artery, necessitating stent graft deployment. Surgical approaches, including stent graft deployment and middle meningeal artery embolization, were effective in managing these cases. Postoperative functional outcomes varied depending on the nature of the hemorrhage, with a subset of patients demonstrating improvement in mRS scores while others showed no significant change.
Emergency hybrid surgical treatment utilizing the E-HOPE platform offers promising outcomes for ICH patients. Tailored surgical approaches result in favorable postoperative functional outcomes, highlighting the importance of a multidisciplinary approach in managing these complex cases.
对急性复杂性颅内出血（ICH）进行精确诊断和快速治疗至关重要。神经外科杂交手术平台将传统的开放式神经外科手术室功能与血管内治疗能力相结合，正在神经外科实践中不断发展。然而，其对急诊复杂神经血管病例的影响需要进行初步探索。
在这项前瞻性研究中，2019年6月至2023年6月期间连续招募了103例自发性和非自发性ICH患者。收集了人口统计学数据，包括年龄、性别分布和出血类型。根据数字减影血管造影（DSA）制定手术干预方案，包括自发性和非自发性出血。术前和术后使用改良Rankin量表（mRS）评估功能结局。
在2019年6月至2023年6月的研究期间，一组103例ICH患者利用E-HOPE平台接受了急诊杂交手术治疗。其中，88例被归类为自发性ICH，15例为非自发性。整个队列的诊断平均年龄为54.0±3.7岁，男性患者略占多数。自发性ICH病因多样，包括动静脉畸形、动脉瘤、动静脉瘘、海绵状畸形、烟雾病和隐源性出血。手术干预根据具体病理情况进行调整。值得注意的是，大多数病例的mRS评分有所改善，部分患者术后病情稳定或恶化。非自发性病例（n = 15）主要为医源性（n = 13），原因是颈内动脉附近的肿瘤，需要进行支架植入。包括支架植入和脑膜中动脉栓塞在内的手术方法对这些病例有效。术后功能结局因出血性质而异，部分患者mRS评分改善，而其他患者无明显变化。
利用E-HOPE平台进行急诊杂交手术治疗为ICH患者带来了有前景的结局。量身定制的手术方法可带来良好的术后功能结局，凸显了多学科方法在处理这些复杂病例中的重要性。
