Uchida Kazutaka, Kuwahara Shuntaro, Tsuji Shoichiro, Sakakibara Fumihiro, Shirakawa Manabu, Yoshimura Shinichi
Department of Neurosurgery, Hyogo Medical University.
Neurol Med Chir (Tokyo). 2025 Jul 15;65(7):303-309. doi: 10.2176/jns-nmc.2024-0340. Epub 2025 May 29.
There is limited high-level evidence guiding the surgical treatment of hypertensive intracerebral hemorrhage, leaving the decision to the clinician's discretion. To understand treatment practices, a questionnaire survey was conducted among members of the Japanese Society on Surgery for Cerebral Stroke. This survey examined stroke care systems at various institutions, stroke numbers, and treatment details of patients with hypertensive intracerebral hemorrhage from January 2021 to December 2023. We examined data from 42 facilities, compared with 10 primary stroke centers cores and 32 non-primary stroke center cores. The total number of physicians involved in stroke care (primary stroke center cores vs. non-primary stroke center cores, median interquartile range; 18 [11-26] vs. 8 [4-14], p = 0.01), stroke specialists (8 [5-12] vs. 4 [2-7], p = 0.03), and supervising stroke surgeons (2 [1-2] vs. 1 [0-2], p = 0.008) was significantly higher in the primary stroke center cores group. Overall, 36,412 patients with stroke were hospitalized: 68% had cerebral infarction, 22% cerebral hemorrhage, 8% subarachnoid hemorrhage, and 2% other strokes. The locations of hypertensive intracerebral hemorrhage varied, with the putamen (31%), thalamus (25%), and lobe (24%) being predominantly affected. Non-invasive treatment was more prevalent in non-primary stroke center cores for most hypertensive intracerebral hemorrhage types, except for putaminal and brainstem hemorrhages. Surgical interventions were more common in primary stroke center cores, with craniotomies, neuroendoscopic surgeries, and ventricular drainage being preferred for cerebellar hemorrhage (28%), caudate nucleus hemorrhage (20%), and intraventricular hemorrhage (41%). This study highlights the treatment variability of hypertensive intracerebral hemorrhage between primary stroke center and non-primary stroke center cores.
目前指导高血压性脑出血外科治疗的高级别证据有限，治疗决策由临床医生自行决定。为了解治疗实践情况，我们对日本脑卒中外科协会的成员进行了问卷调查。本次调查研究了2021年1月至2023年12月期间各机构的卒中护理系统、卒中病例数以及高血压性脑出血患者的治疗细节。我们分析了42家医疗机构的数据，并与10家初级卒中中心核心机构和32家非初级卒中中心核心机构进行了比较。参与卒中护理的医生总数（初级卒中中心核心机构与非初级卒中中心核心机构，中位数四分位间距；18[11 - 26]对8[4 - 14]，p = 0.01）、卒中专科医生（8[5 - 12]对4[2 - 7]，p = 0.03）以及负责指导的卒中外科医生（2[1 - 2]对1[0 - 2]，p = 0.008）在初级卒中中心核心机构组中显著更多。总体而言，共有36412例卒中患者住院：其中68%为脑梗死，22%为脑出血，8%为蛛网膜下腔出血，2%为其他类型卒中。高血压性脑出血的发病部位各不相同，主要累及壳核（31%）、丘脑（25%）和脑叶（24%）。对于大多数高血压性脑出血类型，非侵入性治疗在非初级卒中中心核心机构更为普遍，但壳核和脑干出血除外。外科干预在初级卒中中心核心机构更为常见，小脑出血（28%）、尾状核出血（20%）和脑室内出血（41%）首选开颅手术、神经内镜手术和脑室引流。这项研究突出了初级卒中中心和非初级卒中中心核心机构在高血压性脑出血治疗上的差异。
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