背景:脑出血(ICH)是中风的严重表现,表明全球死亡率和发病率显著上升。到目前为止,已证明ICH的有效治疗策略难以捉摸.目前,微创技术被广泛用于ICH管理,特别是在深部ICH病例中使用内镜下血肿清除术。探索实现细致手术和减少医源性伤害的策略,尤其是皮质脊髓束,为了提高患者的神经预后,需要进一步努力。
方法:我们全面收集了详细的人口统计信息,临床,射线照相,外科,以及内镜下血肿清除术患者的术后治疗和恢复数据。对数据的全面纳入旨在提供我们在本研究中的技术经验的全面概述。
结果:本研究纳入了一百五十四名接受内镜下血肿清除术的深幕上脑出血患者。平均血肿体积为42ml,其中左侧血肿74例,右侧血肿80例。入院时格拉斯哥昏迷量表(GCS)的中位数为10分(范围从4到15),从症状发作到手术的中位时间为18(2至96)h。平均血肿清除率为89%。术后1个月内再出血和死亡率分别为3.2%和7.8%,分别。在6个月大关,改良Rankin量表(mRS)评分为0~3分的患者比例为58.4%。
结论:通过内镜下血肿清除术减少手术相关损伤和保护残余皮质脊髓束可能潜在地增强深部ICH患者的神经功能预后。保证在即将进行的多中心临床研究中进行验证。
BACKGROUND: Intracerebral hemorrhage (ICH) is a severe manifestation of stroke, demonstrating notably elevated global mortality and morbidity. Thus far, effective therapeutic strategies for ICH have proven elusive. Currently, minimally invasive techniques are widely employed for ICH management, particularly using endoscopic hematoma evacuation in cases of deep ICH. Exploration of strategies to achieve meticulous surgery and diminish iatrogenic harm, especially to the corticospinal tract, with the objective of enhancing the neurological prognosis of patients, needs further efforts.
METHODS: We comprehensively collected detailed demographic, clinical, radiographic, surgical, and postoperative treatment and recovery data for patients who underwent endoscopic hematoma removal. This thorough inclusion of data intends to offer a comprehensive overview of our technical experience in this study.
RESULTS: One hundred fifty-four eligible patients with deep supratentorial intracerebral hemorrhage who underwent endoscopic hematoma removal were included in this study. The mean hematoma volume was 42 ml, with 74 instances of left-sided hematoma and 80 cases of right-sided hematoma. The median Glasgow Coma Scale (GCS) score at admission was 10 (range from 4 to 15), and the median time from symptom onset to surgery was 18 (range 2 to 96) h. The mean hematoma clearance rate was 89%. The rebleeding and mortality rates within 1 month after surgery were 3.2% and 7.8%, respectively. At the 6-month mark, the proportion of patients with modified Rankin Scale (mRS) scores of 0-3 was 58.4%.
CONCLUSIONS: Both the reduction of surgery-related injury and the protection of the residual corticospinal tract through endoscopic hematoma removal may potentially enhance neurological functional outcomes in patients with deep ICH, warranting validation in a forthcoming multicenter clinical study.