Objective To explore predictors of the 6-month clinical outcome ofthalamic hemorrhage, and evaluate if minimally invasive thalamic hematoma drainage （THD） could improve its prognosis. Methods A total of 54 patients ...Objective To explore predictors of the 6-month clinical outcome ofthalamic hemorrhage, and evaluate if minimally invasive thalamic hematoma drainage （THD） could improve its prognosis. Methods A total of 54 patients with spontaneous thalamic hemorrhage were evaluated retrospectively. Clinical data, including demographics, stroke risk factors, neuroimaging variables, Glasgow Coma Score （GCS） on admission, surgical strategy, and outcome, were collected. Clinical outcome was assessed using a modified Rankin Scale, six months after onset. Univariate analysis and multivariate logistic regression analysis were performed to determine predictors of a poor outcome. Results Conservative treatnaent was performed for five patients （9.3%）, external ventricular drainage （EVD） for 20 patients （37.0%）, THD for four patients （7.4%）, and EVD combined with THD for 25 patients （46.3%）. At six months after onset, 21 （38.9%） patients achieved a favorable outcome, while 33 （61.1%） had a poor outcome. In the univariate analysis, predictors of poor 6-month outcome were lower GCS on admis- sion （P = 0.001）, larger hematoma volume （P 〈 0.001）, midline shift （P = 0.035）, acute hydrocephalus （P = 0.039）, and no THD （P = 0.037）. The independent predictors of poor outcome, according to the multivariate logistic regression analysis, were no THD and larger hematoma volume. Conclusions Minimally invasive THD, which removes most of the hematoma within a few days, with limited damage to perihematomal brain tissue, improved the 6-month outcome of thalamic hemorrhage. Thus, THD can be widely applied to treat patients with thalamic hemorrhage.展开更多
AIM： This study aimed to expound the individual idea of micro-invasive surgery from pre-operative preparation, intra-operative processing and post-operative management. METHODS： Pre-operative preparation was improve...AIM： This study aimed to expound the individual idea of micro-invasive surgery from pre-operative preparation, intra-operative processing and post-operative management. METHODS： Pre-operative preparation was improved by analyzing pathological factors and hematoma property, and considering patients＇ age, basic disease, blood pressure control, with persistent haemorrhagia/rehaemorrhagia or not, operative occasion choice, positioning and other procedures. In the surgery, positioner was used. Initial aspiration volume was cautiously controlled. After operation, vital signs of patients were kept stable by cautiously using hematoma liquefacient and combining with free radical scavenger. RESULTS： The core content of individual micro-invasive surgery was mainly to relieve intracranial pressure. Under the condition of sufficient pre-operative preparation known by patients＇ family members, precise positioning was determined and individual therapeutic regimen was made. Meanwhile, caution should be taken in hematoma aspiration. Liquefaction and drainage should be paid more attention, and complications were processed actively. CONCLUSION： During the process of micro-invasive evacuation of intracranial hematoma for treating cerebral hemorrhage, attention should be paid to analyzing cerebral hematoma etiology and pathophysiological mechanism, and individual idea should be considered in surgical treatment aiming at patients＇ concrete disease condition.展开更多
Purpose:Rapid decompressive craniectomy(DC)was the most effective method for the treatment of hypertensive intracerebral hemorrhage(HICH)with cerebral hernia,but the mortality and disability rate is still high.We susp...Purpose:Rapid decompressive craniectomy(DC)was the most effective method for the treatment of hypertensive intracerebral hemorrhage(HICH)with cerebral hernia,but the mortality and disability rate is still high.We suspected that hematoma puncture drainage(PD)+DC may improve the therapeutic effect and thus compared the combined surgery with DC alone.Methods:From December 2013 to July 2019,patients with HICH from Linzhi,Tibet and Honghe,Yunnan Province were retrospectively analyzed.The selection criteria were as follows:(1)altitude≥1500 m;(2)HICH patients with cerebral hernia;(3)Glascow coma scale score of 4-8 and time from onset to admission≤3 h;(4)good liver and kidney function;and(5)complete case data.The included patients were divided into DC group and PD+DC group.The patients were followed up for 6 months.The outcome was assessed by Glasgow outcome scale(GOS)score,Kaplan-Meier survival curve and correlation between time from admission to operation and prognosis.A good outcome was defined as independent(GOS score,4-5)and poor outcome defined as dependent(GOS score,3-1).All data analyses were performed using SPSS 19,and comparison between two groups was conducted using separatet-tests or Chi-square tests.Results:A total of 65 patients was included.The age ranged 34-90 years(mean,63.00±14.04 years).Among them,31 patients had the operation of PD+DC,whereas 34 patients underwent DC.The two groups had no significant difference in the basic characteristics.After 6 months of follow-up,in the PD+DC group there were 8 death,4 vegetative state,4 severe disability(GOS score 1-3,poor outcome 51.6%);8 moderate disability,and 7 good recovery(GOS score 4-5,good outcome 48.4%);while in the DC group the result was 15 death,6 vegetative state,5 severe disability(poor outcome 76.5%),4 moderate disability and 4 good recovery(good outcome 23.5%).The GOS score and good outcome were significantly less in DC group than in PD+DC group(Z=-1.993,p=0.046;χ2=4.38,p=0.043).However,there was no significant difference regarding the survival curve between PD+DC group and DC group.The correlation between the time from admission to operation and GOS at 6 months(r=-0.41,R2=0.002,p=0.829)was not significant in the PD+DC group,but significant in the DC group(r=-0.357,R2=0.128,p=0.038).Conclusion:PD+DC treatment can improve the good outcomes better than DC treatment for HICH with cerebral hernia at a high altitude.展开更多
基金This study was supported by National Natural Science Foundation of China （81501054）, and Kejihuimin Project of Shandong Province （2014kjhm0101）.
文摘Objective To explore predictors of the 6-month clinical outcome ofthalamic hemorrhage, and evaluate if minimally invasive thalamic hematoma drainage （THD） could improve its prognosis. Methods A total of 54 patients with spontaneous thalamic hemorrhage were evaluated retrospectively. Clinical data, including demographics, stroke risk factors, neuroimaging variables, Glasgow Coma Score （GCS） on admission, surgical strategy, and outcome, were collected. Clinical outcome was assessed using a modified Rankin Scale, six months after onset. Univariate analysis and multivariate logistic regression analysis were performed to determine predictors of a poor outcome. Results Conservative treatnaent was performed for five patients （9.3%）, external ventricular drainage （EVD） for 20 patients （37.0%）, THD for four patients （7.4%）, and EVD combined with THD for 25 patients （46.3%）. At six months after onset, 21 （38.9%） patients achieved a favorable outcome, while 33 （61.1%） had a poor outcome. In the univariate analysis, predictors of poor 6-month outcome were lower GCS on admis- sion （P = 0.001）, larger hematoma volume （P 〈 0.001）, midline shift （P = 0.035）, acute hydrocephalus （P = 0.039）, and no THD （P = 0.037）. The independent predictors of poor outcome, according to the multivariate logistic regression analysis, were no THD and larger hematoma volume. Conclusions Minimally invasive THD, which removes most of the hematoma within a few days, with limited damage to perihematomal brain tissue, improved the 6-month outcome of thalamic hemorrhage. Thus, THD can be widely applied to treat patients with thalamic hemorrhage.
基金the National Natural Science Foundation of China, No. 3057062830770751
文摘AIM： This study aimed to expound the individual idea of micro-invasive surgery from pre-operative preparation, intra-operative processing and post-operative management. METHODS： Pre-operative preparation was improved by analyzing pathological factors and hematoma property, and considering patients＇ age, basic disease, blood pressure control, with persistent haemorrhagia/rehaemorrhagia or not, operative occasion choice, positioning and other procedures. In the surgery, positioner was used. Initial aspiration volume was cautiously controlled. After operation, vital signs of patients were kept stable by cautiously using hematoma liquefacient and combining with free radical scavenger. RESULTS： The core content of individual micro-invasive surgery was mainly to relieve intracranial pressure. Under the condition of sufficient pre-operative preparation known by patients＇ family members, precise positioning was determined and individual therapeutic regimen was made. Meanwhile, caution should be taken in hematoma aspiration. Liquefaction and drainage should be paid more attention, and complications were processed actively. CONCLUSION： During the process of micro-invasive evacuation of intracranial hematoma for treating cerebral hemorrhage, attention should be paid to analyzing cerebral hematoma etiology and pathophysiological mechanism, and individual idea should be considered in surgical treatment aiming at patients＇ concrete disease condition.
基金supported by Grant No.SWH2017JSZD07 from The First Affiliated Hospital of Army Medical University's"Science and Technology Innovation Program",Grant No.81571116 from the National Natural Science Foundation of China.
文摘Purpose:Rapid decompressive craniectomy(DC)was the most effective method for the treatment of hypertensive intracerebral hemorrhage(HICH)with cerebral hernia,but the mortality and disability rate is still high.We suspected that hematoma puncture drainage(PD)+DC may improve the therapeutic effect and thus compared the combined surgery with DC alone.Methods:From December 2013 to July 2019,patients with HICH from Linzhi,Tibet and Honghe,Yunnan Province were retrospectively analyzed.The selection criteria were as follows:(1)altitude≥1500 m;(2)HICH patients with cerebral hernia;(3)Glascow coma scale score of 4-8 and time from onset to admission≤3 h;(4)good liver and kidney function;and(5)complete case data.The included patients were divided into DC group and PD+DC group.The patients were followed up for 6 months.The outcome was assessed by Glasgow outcome scale(GOS)score,Kaplan-Meier survival curve and correlation between time from admission to operation and prognosis.A good outcome was defined as independent(GOS score,4-5)and poor outcome defined as dependent(GOS score,3-1).All data analyses were performed using SPSS 19,and comparison between two groups was conducted using separatet-tests or Chi-square tests.Results:A total of 65 patients was included.The age ranged 34-90 years(mean,63.00±14.04 years).Among them,31 patients had the operation of PD+DC,whereas 34 patients underwent DC.The two groups had no significant difference in the basic characteristics.After 6 months of follow-up,in the PD+DC group there were 8 death,4 vegetative state,4 severe disability(GOS score 1-3,poor outcome 51.6%);8 moderate disability,and 7 good recovery(GOS score 4-5,good outcome 48.4%);while in the DC group the result was 15 death,6 vegetative state,5 severe disability(poor outcome 76.5%),4 moderate disability and 4 good recovery(good outcome 23.5%).The GOS score and good outcome were significantly less in DC group than in PD+DC group(Z=-1.993,p=0.046;χ2=4.38,p=0.043).However,there was no significant difference regarding the survival curve between PD+DC group and DC group.The correlation between the time from admission to operation and GOS at 6 months(r=-0.41,R2=0.002,p=0.829)was not significant in the PD+DC group,but significant in the DC group(r=-0.357,R2=0.128,p=0.038).Conclusion:PD+DC treatment can improve the good outcomes better than DC treatment for HICH with cerebral hernia at a high altitude.
