评价神经导航辅助立体定向钻孔引流术与开颅手术治疗老年脑出血(ICH)的疗效。这是一个随机的,控制,盲终点临床研究。在我们神经外科治疗的大量脑出血的老年患者,术前没有形成脑疝,所有患者均接受了神经外科手术.将患者随机分为两组:微创手术(MIS)组,接受了神经导航辅助立体定向钻孔引流,开颅血肿清除术(CHRS)组。患者特征,手术麻醉方法,手术持续时间,术中出血量,ICU住院时间并发症,比较两组治疗后90天改良Rankin量表(mRS)评分。对收集的数据进行统计分析。共有67名患者被随机分配,MIS组33例(49.25%),CHRS组34例(50.75%)。与CHRS组相比,MIS集团有优势,包括局部麻醉,手术时间较短,术中出血少,ICU住院时间较短,并发症少(P<0.05)。MIS组在90天时患者预后显著改善(mRS0-3)。然而,两组患者的住院时间和90d生存率比较,差异均无统计学意义(P>0.05)。对于没有脑疝的大量ICH的老年患者,立体定向钻孔引流是一种简单的外科手术,可以在局部麻醉下进行。用这种方法治疗的患者似乎比开颅手术治疗的患者有更好的结果。在临床实践中,神经导航辅助立体定向钻孔引流术推荐用于手术治疗大量ICH无脑疝的老年患者.临床试验登记号:NCT04686877。
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.