OBJECTIVE: To compare neuronavigation-assisted intracerebral hematoma puncture and drainage with neuroendoscopic hematoma removal for treatment of hypertensive cerebral hemorrhage.
METHODS: Ninety-one patients with hypertensive cerebral hemorrhage admitted to our neurosurgery department from June 2022 to May 2023 were selected: 47 patients who underwent endoscopic hematoma removal with the aid of neuronavigation in observation Group A and 44 who underwent intracerebral hematoma puncture and drainage in control Group B. The duration of surgery, intraoperative bleeding, hematoma clearance rate, pre- and postoperative GCS score, National Institutes of Health Stroke Scale (NIHSS) score, mRS score and postoperative complications were compared between the two groups.
RESULTS: The duration of surgery, intraoperative bleeding and hematoma clearance were significantly lower in Group B than in Group A (p < 0.05). Conversely, no significant differences in the preoperative, 7-day postoperative, 14-day postoperative or 1-month postoperative GCS or NIHSS scores or the posthealing mRS score were observed between Groups A and B. However, the incidence of postoperative complications was significantly greater in Group B than in Group A (p < 0.05), with the most significant difference in incidence of intracranial infection (p < 0.05).
CONCLUSIONS: Both neuronavigation-assisted intracerebral hematoma puncture and drainage and neuroendoscopic hematoma removal are effective at improving the outcome of patients with hypertensive cerebral hemorrhage. The disadvantage of neuronavigation is that the incidence of complications is significantly greater than that of other methods; postoperative care and prevention of complications should be strengthened in clinical practice.

Hypertensive Intracerebral Hemorrhage (HICH) is one of the most common types of cerebral hemorrhage with a high mortality and disability rate. Currently, preoperative non-contrast computed tomography (NCCT) scanning-guided stereotactic hematoma removal has achieved good results in treating HICH, but some patients still have poor prognoses. This study collected relevant clinical and radiomic data by retrospectively collecting and analyzing 432 patients who underwent stereotactic hematoma removal for HICH from January 2017 to December 2020 at the Liuzhou Workers Hospital. The prognosis of patients after 90 days was judged by the modified Rankin Scale (mRS) scale and divided into the good prognosis group (mRS ≤ 3) and the poor prognosis group (mRS > 3). The 268 patients were randomly divided into training and test sets in the ratio of 8:2, with 214 patients in the training set and 54 patients in the test set. The least absolute shrinkage and selection operator (Lasso) was used to screen radiomics features. They were combining clinical features and radiomic features to build a joint prediction model of the nomogram. The AUCs of the clinical model for predicting different prognoses of patients undergoing stereotactic HICH were 0.957 and 0.922 in the training and test sets, respectively, while the AUCs of the radiomics model were 0.932 and 0.770, respectively, and the AUCs of the combined prediction model for building a nomogram were 0.987 and 0.932, respectively. Compared with a single clinical or radiological model, the nomogram constructed by fusing clinical variables and radiomic features could better identify the prognosis of HICH patients undergoing stereotactic hematoma removal after 90 days.

OBJECTIVE: This study aims to explore the application potential of 3D visualization technology based in emergency hypertensive cerebral hemorrhage surgery in primary hospitals. The specific goal is to use 3DSlicer software to perform 3D reconstruction and body surface projection on patients with hypertensive cerebral hemorrhage, provide accurate hematoma location information, help surgeons determine the specific location of hematoma on the body surface, and reduce the expansion of surgical incisions.
METHODS: 3D reconstruction technology based on 3DSlicer software was employed to process CT images of patients with cerebral hemorrhage. By segmenting and reconstructing the images, a 3D model of the hematoma was generated and projected onto the patient\'s body surface. Utilizing the functionalities of 3DSlicer software in conjunction with the surgeon\'s anatomical knowledge, accurate hematoma positioning on the body surface was achieved.
RESULTS: 23 patients were enrolled in this study, and underwent successful surgical evacuation. The implementation of 3D visualization technology using 3DSlicer software is expected to provide precise hematoma localization information for emergency hypertensive intracerebral hemorrhage surgery in primary hospitals. This approach will enable surgeons to accurately determine the appropriate surgical incision, thereby minimizing unnecessary trauma and improving the overall success rate of surgery.
CONCLUSIONS: This study demonstrates the potential application of 3D visualization technology based on 3DSlicer software in emergency hypertensive cerebral hemorrhage surgery within primary hospitals. By utilizing 3DSlicer software for hematoma localization, accurate information support can be provided to assist surgeons in managing patients with hypertensive cerebral hemorrhage.

Hypertensive cerebral hemorrhage, the most common prevalent of spontaneous cerebral hemorrhage, poses a significant threat to patient mortality and morbidity, while therapeutic options remain limited, making the disease a burden not only for patients\' families but also a major challenge for national healthcare systems. The elevation of intracranial pressure subsequent to hypertensive cerebral hemorrhage is a critical contributor to mortality. However, it often manifests before the onset of clinical symptoms, which are typically atypical, leading to delayed treatment and irreversible consequences for the patient. Hence, early detection of intracranial pressure variations can aid in timely, efficient, and precise treatment, reducing patient mortality. Invasive intracranial pressure monitoring enables real-time, accurate monitoring of intracranial pressure changes, providing clinicians with therapeutic guidance and overcoming the limitations of empirical treatment. This article aims to review the use of invasive intracranial pressure monitoring in postoperative hypertensive cerebral hemorrhage and hopes to contribute to clinical and scientific research.

UNASSIGNED: The aim of this study was to evaluate the effects of stereotactic minimally invasive puncture with different catheter placement positions when combined with urokinase thrombolysis for the treatment of small- and medium-volume basal ganglia hemorrhage. Our goal was to identify the best minimally invasive catheter placement position to enhance therapeutic efficacy for patients with cerebral hemorrhage.
UNASSIGNED: The stereotactic minimally invasive thrombolysis at different catheter positions in the treatment of small- and medium-volume basal ganglia hemorrhage (SMITDCPI) was a randomized, controlled, and endpoint phase 1 trial. We recruited patients with spontaneous ganglia hemorrhage (medium-to-small and medium volume) who were treated in our hospital. All patients received stereotactic, minimally invasive punctures combined with an intracavitary thrombolytic injection of urokinase hematoma. A randomized number table method was used to divide the patients into two groups concerning the location of catheterization: a penetrating hematoma long-axis group and a hematoma center group. The general conditions of the two groups of patients were compared, and the data were analyzed, including the time of catheterization, the dosage of urokinase, the amount of residual hematoma, the hematoma clearance rate, complications, and the National Institute of Health stroke scale (NIHSS) score data at 1 month after surgery.
UNASSIGNED: Between June 2019 and March 2022, 83 patients were randomly recruited and assigned to the two groups as follows: 42 cases (50.60%) to the penetrating hematoma long-axis group and 41 cases (49.40%) to the hematoma center group. Compared with the hematoma center group, the long-axis group was associated with a significantly shorter catheterization time, a lower urokinase dose, a lower residual hematoma volume, a higher hematoma clearance rate, and fewer complications (P < 0.05). However, there were no significant differences between the two groups in terms of the NIHSS scores when tested 1 month after surgery (P > 0.05).
UNASSIGNED: Stereotactic minimally invasive puncture combined with urokinase for the treatment of small- and medium-volume hemorrhage in the basal ganglia, including catheterization through the long axis of the hematoma, led to significantly better drainage effects and fewer complications. However, there was no significant difference in short-term NIHSS scores between the two types of catheterization.

BACKGROUND: Hypertensive cerebral hemorrhage (HICH) is a common clinical cerebrovascular disease and one of the most serious complications of hypertension. Early warning of the occurrence of infection during treatment and timely anti-infective treatment are of great significance for the early prevention and treatment of postoperative infection in patients with HICH. Changes in the levels of inflammatory mediators, which are closely related to the occurrence and development of postoperative infection, and procalcitonin (PCT), which is a sensitive indicator for diagnosing bacterial infections, are widely used in clinical practice.
OBJECTIVE: To explore the application value of inflammatory mediator profiles and PCT in predicting postoperative infection in patients with HICH.
METHODS: A total of 271 patients who underwent HICH surgery at our hospital between March 2019 and March 2021 were selected and divided into the infection (n = 80) and non-infection (n = 191) groups according to whether postoperative infection occurred. The postoperative infection status and etiological characteristics of the infective pathogens in the infection group were analyzed. Changes in inflammatory mediator profile indices and PCT levels were compared between the two groups, pre- and postoperatively.
RESULTS: A total of 109 strains of pathogenic bacteria were detected in the infection group, including 67 strains (61.47%) of gram-negative bacteria, 32 strains (29.36%) of gram-positive bacteria, and 10 strains (9.17%) of fungi. The main infection site of the patients in the infection group was the respiratory system (63.75%). Preoperative interleukin (IL)-4, IL-6, IL-10, tumor necrosis factor-α, interferon-γ, and PCT levels were higher in the infection group than in the non-infection group (P < 0.05), and there were no significant differences in the IL-2 Levels between the two groups (P > 0.05). The inflammatory mediator profile indices and PCT levels were higher in the two groups of patients on the first postoperative day than preoperatively (P < 0.05), and were higher than those in the non-infection group (P < 0.05). Logistic regression analysis showed that preoperative IL-6 and PCT levels correlated with postoperative infection (P < 0.05). Operating characteristic curve analysis results showed that the area under the curve (AUC) values of preoperative IL-6 and PCT levels in predicting postoperative infection in patients with HICH were 0.755 and 0.824, respectively. The AUC value of joint detection was 0.866, which was significantly higher than that of the single index (P < 0.05).
CONCLUSIONS: Preoperative IL-6 and PCT levels are correlated with postoperative infection in patients with HICH. Their detection is clinically significant for early identification of patients at high risk for postoperative infection.

BACKGROUND: Surgery plays a major role in treating hypertensive cerebral hemorrhage in the basal ganglia; however, some patients suffer from neurological impairment after surgery. Studies have confirmed that stereotactic hematoma aspiration guided by computed tomography (CT) has significant value for patients with hypertensive intracerebral hemorrhage in the basal ganglia, but little is known about the optimal timing for the operation. This study sought to explore the effect of CT-guided stereotactic hematoma aspiration timing on the recovery of neurological function in patients with hypertensive cerebral hemorrhage in the basal ganglia.
METHODS: The data of 110 patients with hypertensive cerebral hemorrhage in the basal ganglia admitted to the Union Hospital Tongji Medical College Huazhong University of Science and Technology from January 2021 to December 2021 were retrospectively collected. Based on the timing of their operations, the patients were allocated to the early treatment group (within 24 hours, n=50) and late treatment group (after 24 hours, n=60). The postoperative recovery of the 2 groups was compared.
RESULTS: There were no significant differences in terms of age, gender, amount of cerebral hemorrhage, hemorrhage ruptured into ventricle rate, Glasgow Coma Scale score, hypertension grade, hyperlipidemia, diabetes, and operation duration between the 2 groups (P>0.05). Additionally, there was no difference in the preoperative National Institute of Health Stroke Scale scores of the patients in the 2 groups (22.50±4.90 vs. 23.83±5.35, P=0.179). Compared to the late treatment group, the National Institute of Health Stroke Scale score of the patients in the early treatment group was significantly lower 3 and 6 months after the operation (5.90±4.02 vs. 9.23±3.47, P<0.001; 4.54±2.56 vs. 6.50±3.07, P<0.001, respectively). The Glasgow Outcome Scale score of patients in the early treatment group was significantly better than that of patients in the late treatment group (P=0.035). No significant difference was found in the incidence of postoperative pulmonary infection, intracranial infection, rebleeding, and lower extremity deep venous thrombosis between the 2 groups (P>0.05).
CONCLUSIONS: Early CT-guided stereotactic hematoma aspiration may improve the postoperative neurological function of patients with hypertensive cerebral hemorrhage in the basal ganglia.

UNASSIGNED: Surgery is the main method for the clinical treatment of hypertensive cerebral hemorrhage. Traditional craniotomy faces the disadvantages of the long operation time, easy to cause secondary injury to patients during the operation, and prone to infection after the operation, which is not conducive to the rehabilitation of patients. At present, it is urgent to find a surgical scheme, which can clear hematoma in time, protect brain tissue, and effectively reduce surgical trauma in the clinic.
UNASSIGNED: The case database of our hospital was consulted, and the clinical data of patients with hypertensive intracerebral hemorrhage (HICH) treated with soft channel minimally invasive puncture and drainage from February 2018 to October 2021 were retrospectively analyzed. Patients were evaluated for efficacy, and the changes in serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), homocysteine (Hcy), endothelin (ET), and vasopressin (AVP) levels before surgery, 3 days after surgery, and 7 days after surgery were analyzed. Clinical data were collected and Logistic regression was used to analyze the prognostic factors.
UNASSIGNED: Finally, according to the inclusion and exclusion criteria, 126 patients were selected as the research object. Among them, there were 24 cases (19.05%) of recovery, 47 cases (37.30%) of markedly effective, 34 cases (26.98%) of effective, 11 cases (8.73%) of ineffective, and 10 cases (7.94%) of death. The total effective rate was 83.33%. The hematoma was basically removed in 116 cases (92.06%). The average evacuation time of hematoma was (7.82 ± 1.63) days. Post-operative intracranial infection occurred in 2 cases (1.59%) and post-operative rebleeding occurred in 5 cases (3.97%). The average hospital stay was (34.16 ± 16.59) days. Serum CRP, TNF-α, IL-6, Hcy, ET, and AVP levels of all patients on the third and seventh days after surgery were lower than those before surgery, and those on the seventh day after surgery were lower than those on the third day after surgery (p < 0.05). The differences in pre-operative Glasgow Coma Scale (GCS) score, bleeding volume, ventricular rupture, complicated cerebral hernia, and attack time to surgery between the good prognosis group and the bad prognosis group were statistically significant (p < 0.05). Pre-operative GCS score, bleeding volume, ventricular rupture, complicated cerebral hernia, and onset time to surgery were all independent factors that affect the prognosis of patients (p < 0.05).
UNASSIGNED: Soft-channel minimally invasive puncture and drainage treatment of HICH has a significant effect, which is conducive to the complete removal of hematoma, reducing hospitalization time, while adjusting the balance and stability of various cytokines, and improving patient prognosis. Pre-operative GCS score, bleeding volume, rupture into the ventricle, complicated cerebral hernia, and time from onset to operation are all independent factors that affect the prognosis of patients.

OBJECTIVE: To explore the dissolution effect of alteplase (rt-PA) on arterial blood clots of patients with hypertensive cerebral hemorrhage in vitro and analyze the optimal concentration and action time of rt-PA for intracranial hematomas.
METHODS: The arterial blood of 35 patients with confirmed hypertensive cerebral hemorrhage were collected, centrifuged, and the serum was aspirated to prepare the blood clot model. The 0.125, 0.25, 0.5, 1, 2, and 3 mg t-PA, 20,000 U, and 40,000 U urokinase (u-PA) were taken for the corresponding blood clot for dissolution test. The blood clot volume and dissolution volume was measured at 0, 30, 60, 90, 120, and 150 min.
RESULTS: Without intervention, the blood clot volume of men was higher than that of women at 0, 30, 60, and 90 min (P < 0.05). Without intervention, hematocrit (HCT) was correlated with blood clot volume and the correlation decreased with time. The 30, 60, and 90 min dissolution curves of each group showed an upward trend (P < 0.05), and the dissolution curves tended to be flat at 120 min and 150 min. The dissolution volume of.125 mg/3 ml, 0.25 mg/3 ml, 0.5 mg/3 ml rt-PA, 20,000 U, 40,000 U u-PA was higher than that of 1, 2, 3 mg/ml rt-PA (P < 0.05). The dissolution volume of.125 mg/3 ml, 0.25 mg/3 ml, 0.5 mg/3 ml rt-PA was not significantly different from 20,000 and 40,000 U u-PA (P > 0.05). Gender differences did not affect the effects of the above drugs.
CONCLUSIONS: In vitro, low-concentration rt-PA has a better dissolution effect, and it shows a time-dependent effect, reaching the highest effect in 90 min.

To analyze the correlation between thrombospondin-2 (TSP2), matrix metalloproteinase (MMP)-9, and perihematomal edema, as well as the short-term prognosis of patients with hypertensive intracerebral hemorrhage.
The clinical data of 114 patients with hypertensive intracerebral hemorrhage admitted to our hospital from January 2018 to February 2020 were collected and divided into groups according to the levels of TSP2 and MMP-9. We compared edema indexes in patients with different levels of TSP2 and MMP-9, and analyzed the correlation between TSP2, MMP-9 and relative edema volume index (REI), edema change index (AEI). We also assessed the TSP2 and MMP-9 levels in patients with different prognoses, and analyzed the predictive value of TSP2 and MMP-9 for poor prognosis of patients.
(I) There was no difference in the REI and AEI values between the low and high TSP2 groups at admission and 24 h after admission (P>0.05), while the REI and AEI values of the high TSP2 group at 5 and 15 d after admission were significantly lower than those of the low TSP2 group (P<0.05); (II) the REI and AEI values of patients with different MMP-9 levels were not different between admission and 24 h after admission (P>0.05), while the REI and AEI values of the high MMP-9 group were significantly higher than those of the low MMP-9 group at 5 and 15 d after admission (P<0.05); (III) Pearson correlation analysis showed that MMP-9 was positively correlated with REI and AEI, while TSP2 was negatively correlated (P<0.05); (IV) among 114 patients, 39 had poor prognosis, 75 had good prognosis The MMP-9 levels of patients with a poor prognosis were significantly higher than those of patients with a good prognosis, and the TSP2 level was the opposite (P<0.05); (V) receiver operating characteristic (ROC) curve showed that the sensitivity, specificity and the area under the curve (AUC) of the TSP2 + MMP-9 combination in the diagnosis of hypertensive cerebral hemorrhage were significantly higher than when TSP2 and MMP-9 were tested separately (P<0.05).
In patients with hypertensive intracerebral hemorrhage, TSP2 is negatively correlated with edema around the hematoma, while MMP-9 is positively correlated.