Short-term efficacy prediction of neuronavigation-guided treatment of basal ganglia hypertensive intracerebral hemorrhage

doi:10.3877/cma.j.issn.2095-123X.2024.03.005

Abstract

Abstract:

Objective

To explore and predict the short-term efficacy of neuronavigation-guided treatment for basal ganglia hypertensive intracerebral hemorrhage (HICH).

Methods

A retrospective analysis was conducted on the clinical data of 56 patients with basal ganglia HICH admitted to Neurosurgery Department of Liaoning Provincial People's Hospital from January 2020 to June 2021. According to different puncture positioning methods, they were divided into two groups. The control group (35 cases) received traditional localization puncture treatment, while the experimental group (21 cases) received neuronavigation-guided localization puncture treatment. The GCS score at 1 week after surgery, complications and the Barthel index (BI) score at 6 months after surgery between the two groups were compared. Multivariate Logistic regression were used to analyze the benefit factors of different surgical methods for basal ganglia HICH, and the R software was used to construct a nomogram risk prediction model and verify the effect.

Results

There was no statistical difference in intra-pulmonary infections, and the incidence of stress ulcers between the two groups (P>0.05). The experimental group had a higher GCS score at 1 week after surgery than the control group, lower residual blood volume and hospitalization days than the control group, the longer surgical operation time than the control group, and the BI score at 6 months after treatment was better than that of the control group, with statistical significances (P<0.05). Multivariate Logistic regression analysis showed that postoperative residual blood volume and hospitalization days were independent benefit factors. The internal verification of the Bootstrap method showed that the calibration curve showed that the model was well calibrated.

Conclusion

Surgical treatment of basal ganglia HICH assisted by neuronavigation can reduce postoperative intracerebral residual blood and hospitalization days, promote the recovery of long-term self-care ability after surgery, and provide a new therapeutic option for promoting the rehabilitation of cerebral hemorrhage patients and early return to society.

Key words: Hypertensive intracerebral hemorrhage, Basal ganglia, Neuronavigation, Surgical treatment, Nomogram

Fangkun Jing, Jianbo Zhou, Quancai Wang, Haitao Huang, Yanfeng Li, Yangxi Xu. Short-term efficacy prediction of neuronavigation-guided treatment of basal ganglia hypertensive intracerebral hemorrhage[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2024, 14(03): 154-159.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhnkjbykfzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-123X.2024.03.005

https://zhnkjbykfzz.cma-cmc.com.cn/EN/Y2024/V14/I03/154

Figures/Tables 4

References 21

[1]	Feigin VL, Lawes CM, Bennett DA, et al. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review[J]. Lancet Neurol, 2009, 8(4): 355-369. DOI: 10.1016/s1474-4422(09)70025-0.
[2]	Ru X, Wang W, Sun H, et al. Geographicaldifference, rural-urban transition and trend in stroke prevalence in China: findings from a national epidemiological survey of stroke in China[J]. Sci Rep, 2019, 9(1): 17330. DOI: 10.1038/s41598-019-53848-1.
[3]	Wang A, Sun Z, Zhang W, et al. Efficacy and safety of endoscopic surgery versus craniotomy for hypertensive putamen hemorrhage[J]. J Craniofac Surg, 2024, 35(4): 1181-1185. DOI: 10.1097/scs.0000000000010105.
[4]	Katsuki M, Narita N, Sato K, et al. Where to make burr hole for endoscopic hematoma removal against intracerebral hemorrhage at the basal ganglia to increase the hematoma removal rate-comparison between trans-forehead and along-the-long-axis approaches[J]. Surg Neurol Int, 2021, 12: 41. DOI: 10.25259/sni_887_2020.
[5]	Jiang L, Tian J, Guo C, et al. Comparison of the efficacy of neuronavigation-assisted intracerebral hematoma puncture and drainage with neuroendoscopic hematoma removal in treatment of hypertensive cerebral hemorrhage[J]. BMC Surg, 2024, 24(1): 86. DOI: 10.1186/s12893-024-02378-3.
[6]	徐昌林,程浩,刘从国,等. Rosa定位钻孔血肿清除术与经验性定位颅骨钻孔血肿清除术治疗自发性脑出血的疗效对比分析[J].中华神经创伤外科电子杂志, 2023, 9(2): 97-101. DOI: 10.3877/cma.j.issn.2095-9141.2023.02.006.
[7]	Dastur CK, Yu W. Current management of spontaneous intracerebral haemorrhage[J]. Stroke Vasc Neurol, 2017, 2(1): 21-29. DOI: 10.1136/svn-2016-000047.
[8]	Amarenco P. Transient ischemic attack[J]. N Engl J Med, 2020, 382(20): 1933-1941. DOI: 10.1056/NEJMcp1908837.
[9]	Xue M, Yong VW. Neuroinflammation in intracerebral haemorrhage: immunotherapies with potential for translation[J]. Lancet Neurol, 2020, 19(12): 1023-1032. DOI: 10.1016/s1474-4422(20)30364-1.
[10]	Wei LJ, Lin C, Xue XS, et al. The effect of hematoma puncture drainage before decompressive craniectomy on the prognosis of hypertensive intracerebral hemorrhage with cerebral hernia at a high altitude[J]. Chin J Traumatol, 2021, 24(6): 328-332. DOI: 10.1016/j.cjtee.2021.08.006.
[11]	Mendelow AD, Gregson BA, Rowan EN, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): A randomised trial[J]. Lancet, 2013, 382(9890): 397-408. DOI: 10.1016/s0140-6736(13)60986-1.
[12]	de Oliveira Manoel AL. Surgery for spontaneous intracerebral hemorrhage[J]. Crit Care, 2020, 24(1): 45. DOI: 10.1186/s13054-020-2749-2.
[13]	Li Y, Yang R, Li Z, et al. Surgical evacuation of spontaneous supratentorial lobar intracerebral hemorrhage: comparison of safety and efficacy of stereotactic aspiration, endoscopic surgery, and craniotomy[J]. World Neurosurg, 2017, 105: 332-340. DOI: 10.1016/j.wneu.2017.05.134.
[14]	Leksell L, Lindquist C, Adler JR, et al. A new fixation device for the leksell stereotaxic system. Technical note[J]. J Neurosurg, 1987, 66(4): 626-629. DOI: 10.3171/jns.1987.66.4.0626.
[15]	Spiegel EA, Wycis HT, et al. Stereoencephalotomy[J]. Proc Soc Exp Biol Med, 1948, 69(1): 175-177. DOI: 10.3181/00379727-69-16658p.
[16]	Atteya MME. Frameless stereotaxy: it is all about precision[J]. Childs Nerv Syst, 2020, 36(1): 179-187. DOI: 10.1007/s00381-019-04390-y.
[17]	Hostettler IC, Seiffge DJ, Werring DJ. Intracerebral hemorrhage: An update on diagnosis and treatment[J]. Expert Rev Neurother, 2019, 19(7): 679-694. DOI: 10.1080/14737175.2019.1623671.
[18]	Lian M, Li X, Wang Y, et al. Comparison of two minimally invasive surgical approaches for hypertensive intracerebral hemorrhage: A study based on postoperative intracranial pressure parameters[J]. BMC Surg, 2024, 24(1): 10. DOI: 10.1186/s12893-023-02306-x.
[19]	钱晟,杨珉,许先平,等.导航辅助神经内镜硬通道微创治疗基底节区高血压脑出血的疗效及安全性分析[J].川北医学院学报, 2023, 38(3): 323-327. DOI: 10.3969/j.issn.1005-3697.2023.03.008.
[20]	姚瀚勋,夏学巍,肖晶,等.导航辅助神经内镜硬通道技术治疗基底节区高血压脑出血患者的临床疗效[J].重庆医学, 2018, 47(8): 1055-1057. DOI: 10.3969/j.issn.1671-8348.2018.08.014.
[21]	黄毅,黄常坚,黄建荣. 3D Slicer软件联合手机导航辅助神经内镜手术治疗基底节区高血压脑出血患者的临床效果[J].广西医学, 2022, 44(12): 1425-1428. DOI: 10.11675/j.issn.0253-4304.2022.12.24.

项目	对照组（n=35）	试验组（n=21）	t/χ²值	P值
年龄（岁，Mean±SD）	71.11±6.62	72.10±7.09	0.522	0.604
性别[例（%）]			0.123	0.726
男	20（57.14）	13（61.90）
女	15（42.86）	8（38.10）
出血量（mL，Mean±SD）	38.57±8.81	36.00±2.36	1.011	0.317
吸烟史[例（%）]	30（85.71）	15（71.43）	1.697	0.193
饮酒史[例（%）]	23（65.71）	10（47.62）	1.776	0.183
糖尿病[例（%）]	12（34.29）	9（42.86）	0.411	0.521
心血管疾病[例（%）]	6（17.14）	5（23.81）	0.370	0.543
术前C-反应蛋白（mg/L，Mean±SD）	51.43±20.20	53.95±15.35	0.493	0.624
术前GCS评分（分，Mean±SD）	11.00±2.54	11.19±1.63	0.307	0.760

项目	对照组（n=35）	试验组（n=21）	t/χ²值	P值
年龄（岁，Mean±SD）	71.11±6.62	72.10±7.09	0.522	0.604
性别[例（%）]			0.123	0.726
男	20（57.14）	13（61.90）
女	15（42.86）	8（38.10）
出血量（mL，Mean±SD）	38.57±8.81	36.00±2.36	1.011	0.317
吸烟史[例（%）]	30（85.71）	15（71.43）	1.697	0.193
饮酒史[例（%）]	23（65.71）	10（47.62）	1.776	0.183
糖尿病[例（%）]	12（34.29）	9（42.86）	0.411	0.521
心血管疾病[例（%）]	6（17.14）	5（23.81）	0.370	0.543
术前C-反应蛋白（mg/L，Mean±SD）	51.43±20.20	53.95±15.35	0.493	0.624
术前GCS评分（分，Mean±SD）	11.00±2.54	11.19±1.63	0.307	0.760

项目	对照组（n=35）	试验组（n=21）	t/χ²值	P值
术后GCS评分（分，Mean±SD）	12.95±1.56	14.00±0.91	3.176	0.020
术后残余血量（mL，Mean±SD）	17.51±5.48	14.19±4.64	2.321	0.020
手术时间（min，Mean±SD）	41.29±3.08	49.51±2.68	3.708	0.042
住院天数（d，Mean±SD）	25.79±2.22	20.22±0.96	3.723	0.011
住院费用（万元，Mean±SD）	4.43±1.34	4.68±0.95	0.726	0.471
术后并发症[例（%）]
肺内感染	18（51.43）	12（57.14）	0.172	0.678
应激性溃疡	8（22.86）	4（19.05）	0.113	0.737
Barthel指数评分>60分[例（%）]	12（36.36）	13（65.00）	4.098	0.043
死亡[例（%）]	2（5.714）	1（4.762）	0.037	>0.999

项目	对照组（n=35）	试验组（n=21）	t/χ²值	P值
术后GCS评分（分，Mean±SD）	12.95±1.56	14.00±0.91	3.176	0.020
术后残余血量（mL，Mean±SD）	17.51±5.48	14.19±4.64	2.321	0.020
手术时间（min，Mean±SD）	41.29±3.08	49.51±2.68	3.708	0.042
住院天数（d，Mean±SD）	25.79±2.22	20.22±0.96	3.723	0.011
住院费用（万元，Mean±SD）	4.43±1.34	4.68±0.95	0.726	0.471
术后并发症[例（%）]
肺内感染	18（51.43）	12（57.14）	0.172	0.678
应激性溃疡	8（22.86）	4（19.05）	0.113	0.737
Barthel指数评分>60分[例（%）]	12（36.36）	13（65.00）	4.098	0.043
死亡[例（%）]	2（5.714）	1（4.762）	0.037	>0.999

项目	偏回归系数	标准误	Z值	Wald值	P值	OR（95%CI）
常数	-12.510	6.211	2.447	4.057	0.014	-
术后GCS评分	0.317	0.301	1.113	1.109	0.266	1.397（0.795~2.668）
术后残余血量	0.169	0.085	2.254	3.953	0.024	1.212（1.042~1.466）
手术时间	0.042	0.034	1.613	1.526	0.107	1.057（0.992~1.139）
住院天数	0.269	0.079	2.513	11.594	0.012	1.219（1.064~1.462）
Barthel指数评分>60分	-0.132	0.789	1.662	0.028	0.097	3.713（0.862~20.310）

Please choose a citation manager

Content to export