Effect of minimally invasive surgery for intracerebral hemorrhage: a single center retrospective analysis

doi:10.3877/cma.j.issn.2095-123X.2022.01.003

Abstract

Abstract:

Objective

To evaluated the safety, efficacy and longterm prognosis of different minimally invasive surgery treatments in patient with intracerebral hemorrhage (ICH).

Methods

Patients with basal ganglia hemorrhage, admitted to Neurosurgery Department of Second Affiliated Hospital, School of Medicine, Zhejiang University from January 2019 to December 2020, were divided into three groups: small bone window craniotomy (SBWC) group, endoscopic surgery (ES) group and stereotactic hematoma aspiration followed by urokinase (SHAU) group. The baseline characteristics, perioperative information and lone-term outcome data of the three groups were analyzed to evaluate the safety and effectiveness of different minimally invasive treatments in the treatment of ICH.

Results

There were 356 patients in this group, including 116 cases in ES group, 135 cases in SHAU group and 105 cases in SBWC group. No significant differences were observed among all three groups the baseline characteristics, including age, sex, hematoma location, GCS score, NIHSS score and hematoma volume (P>0.05). There were significant differences among the three groups with respect to the operative blood loss and operative time (P<0.05). The rebleeding rate in the SHAU groups was significantly higher than in the other two groups (P<0.05). The evacuation rate 24 h after operation in AMWC and ES groups was significantly higher than SHAU group (P<0.05). The evacuation rate 3 d after operation in ES group was better than that in SBWC group and SHAU group (P<0.05), but there was no significant difference between SBWC group and SHAU group (P>0.05). On 7 d after surgery, the NIHSS score in ES and SHAU groups were significantly higher than the AMWC group, the good prognosis rate in ES and SHAU groups were significantly higher than the AMWC group (P<0.05). Six months after surgery, the NIHSS score in ES and SHAU groups were significantly higher than the AMWC group, the good prognosis rate in ES and SHAU groups were significantly higher than the AMWC group (P<0.05).

Conclusion

Minimally invasive surgery has a definite effect on the treatment of ICH and can significantly improve the long-term outcome. Among them, endoscopic surgery has high hematoma removal efficiency and fewer complications.

Key words: Intracerebral hemorrhage, Minimally invasive surgery, Endoscopic, Stereotactic hematoma aspiration, Craniotomy

Xiaoxiao Tan, Xiongjie Fu, Xiaobo Yu, Feng Yan, Gao Chen. Effect of minimally invasive surgery for intracerebral hemorrhage: a single center retrospective analysis[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2022, 12(01): 21-26.

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References 17

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项目	内镜组（n=116）	立体定向组（n=135）	小骨窗开颅组（n=105）	χ²/F值	P值
性别[男，例（%）]	72（62.07）	90（66.67）	60（57.14）	2.289	0.318
年龄（岁，Mean±SD）	62.1±13.9	64.2±9.4	60.7±9.7	2.995	0.412
吸烟史[例（%）]	69（59.48）	84（62.22）	59（56.20）	0.892	0.640
饮酒史[例（%）]	55（47.41）	61（45.93）	52（49.52）	0.450	0.790
高血压[例（%）]	82（70.69）	102（75.56）	78（75.29）	0.797	0.670
糖尿病[例（%）]	35（30.17）	45（33.33）	33（31.43）	0.294	0.860
GCS评分（分，Mean±SD）	7.0±2.8	6.9±3.3	6.8±0.7	0.507	0.776
NIHSS评分（分，Mean±SD）	21.8±4.7	22.9±4.1	22.5±5.0	2.790	0.238
发病至手术时间（h，Mean±SD）	12.0±1.3	12.6±1.2	12.3±2.3	1.720	0.243
血肿体积（mL，Mean±SD）	45.2±10.2	45.6±12.3	44.2±11.5	1.848	0.530
血肿位置（左/右）	60/56	70/65	54/51	0.004	0.990

项目	内镜组（n=116）	立体定向组（n=135）	小骨窗开颅组（n=105）	χ²/F值	P值
性别[男，例（%）]	72（62.07）	90（66.67）	60（57.14）	2.289	0.318
年龄（岁，Mean±SD）	62.1±13.9	64.2±9.4	60.7±9.7	2.995	0.412
吸烟史[例（%）]	69（59.48）	84（62.22）	59（56.20）	0.892	0.640
饮酒史[例（%）]	55（47.41）	61（45.93）	52（49.52）	0.450	0.790
高血压[例（%）]	82（70.69）	102（75.56）	78（75.29）	0.797	0.670
糖尿病[例（%）]	35（30.17）	45（33.33）	33（31.43）	0.294	0.860
GCS评分（分，Mean±SD）	7.0±2.8	6.9±3.3	6.8±0.7	0.507	0.776
NIHSS评分（分，Mean±SD）	21.8±4.7	22.9±4.1	22.5±5.0	2.790	0.238
发病至手术时间（h，Mean±SD）	12.0±1.3	12.6±1.2	12.3±2.3	1.720	0.243
血肿体积（mL，Mean±SD）	45.2±10.2	45.6±12.3	44.2±11.5	1.848	0.530
血肿位置（左/右）	60/56	70/65	54/51	0.004	0.990

组别	例数	手术时长（min）	术中出血量（mL）
内镜组	116	85.7±25.8	65.2±14.7
立体定向组	135	50.0±8.5^a	20.2±5.3^a
小骨窗开颅组	105	162.4±25.3^ab	185.7±45.2^ab
F值		878.900	1228.000
P值		<0.001	<0.001

组别	例数	手术时长（min）	术中出血量（mL）
内镜组	116	85.7±25.8	65.2±14.7
立体定向组	135	50.0±8.5^a	20.2±5.3^a
小骨窗开颅组	105	162.4±25.3^ab	185.7±45.2^ab
F值		878.900	1228.000
P值		<0.001	<0.001

项目		内镜组（n=116）	立体定向组（n=135）	小骨窗开颅组（n=105）	χ²/F值	P值
术后并发症情况[例（%）]
	术后再出血	5（4.31）	15（11.11）	4（3.81）	6.626	0.036
	颅内感染	5（4.31）	6（4.45）	12（11.43）	6.084	0.047
	肺部感染	4（3.45）	5（3.31）	11（10.5）	6.637	0.036
	消化道出血	6（5.17）	7（5.19）	7（6.67）	0.309	0.857
	癫痫	2（1.72）	2（1.48）	3（2.86）	0.632	0.729
术后24 h血肿清除率（%，Mean±SD）		89.7±2.3	80.3±9.5	83.5±3.3	2642.000	<0.001
术后3 d血肿清除率（%，Mean±SD）		93.7±2.3	87.7±2.7	87.4±2.4	29.130	<0.001
术后7 d NIHSS评分（分，Mean±SD）		15.2±2.5	17.9±3.2	20.3±4.6	84.930	<0.001
术后7 d mRs评分[例（%）]					36.060	<0.001
	0~3分	71（61.21）	77（57.04）	25（23.81）
	4~6分	45（38.79）	58（42.96）	80（76.19）
住院时长（d，Mean±SD）		10.3±2.3	9.5±2.2	14.5±2.6	155.700	<0.001

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