A new surgical method of treatment spontaneous intracranial hemorrhage

Du, Ning; Wang, Xinjun; Zhang, Xuyang; Xie, Jierui; Zhou, Shaolong; Wu, Yuehui; Guo, Yingshu

doi:10.1515/tnsci-2020-0164

Cited by 5 publications

(2 citation statements)

References 24 publications

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“…Surely, the technique is open for further improvement, for example a more specific and elaborated planning of the trajectory by using DTI to determine – and thereby sparing –the white matter tracts [as, e.g., reported by Du et al, Steineke and Barbery and Zhang et al ( 44 – 46 )] and also predict clinical outcome ( 47 , 48 ). Additionally, the supplement of tractography could be used to further evaluate the presence and role of surviving white matter tracts within the hematoma that are thought to be at risk for damage by the surgical intervention ( 22 , 23 ).…”

Section: Discussionmentioning

confidence: 99%

Minimally-invasive bedside catheter haematoma aspiration followed by local thrombolysis in spontaneous supratentorial intracerebral haemorrhage: a retrospective single-center study

Hieber,

Lambeck,

Halaby

et al. 2023

Front. Neurol.

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Background and purposeThe role of surgery in the treatment of intracerebral haemorrhage (ICH) remains controversial. Whereas open surgery has failed to show any clinical benefit, recent studies have suggested that minimal invasive procedures can indeed be beneficial, especially when they are applied at an early time point. This retrospective study therefore evaluated the feasibility of a free-hand bedside catheter technique with subsequent local lysis for early haematoma evacuation in patients with spontaneous supratentorial ICH.MethodsPatients with spontaneous supratentorial haemorrhage of a volume of >30 mL who were treated with bedside catheter haematoma evacuation were identified from our institutional database. The entry point and evacuation trajectory of the catheter were based on a 3D-reconstructed CT scan. The catheter was inserted bedside into the core of the haematoma, and urokinase (5,000 IE) was administered every 6 h for a maximum of 4 days. Evolution of haematoma volume, perihaemorrhagic edema, midline-shift, adverse events and functional outcome were analyzed.ResultsA total of 110 patients with a median initial haematoma volume of 60.6 mL were analyzed. Haematoma volume decreased to 46.1 mL immediately after catheter placement and initial aspiration (with a median time to treatment of 9 h after ictus), and to 21.0 mL at the end of urokinase treatment. Perihaemorrhagic edema decreased significantly from 45.0 mL to 38.9 mL and midline-shift from 6.0 mm to 2.0 mm. The median NIHSS score improved from 18 on admission to 10 at discharge, and the median mRS at discharge was 4; the latter was even lower in patients who reached a target volume ≤ 15 mL at the end of local lysis. The in-hospital mortality rate was 8.2%, and catheter/local lysis-associated complications occurred in 5.5% of patients.ConclusionBedside catheter aspiration with subsequent urokinase irrigation is a safe and feasible procedure for treating spontaneous supratentorial ICH, and can immediately reduce the mass effects of haemorrhage. Additional controlled studies that assess the long-term outcome and generalizability of our findings are therefore warranted.Clinical trial registration[www.drks.de], identifier [DRKS00007908].

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Section: Discussionmentioning

confidence: 99%

Minimally-invasive bedside catheter haematoma aspiration followed by local thrombolysis in spontaneous supratentorial intracerebral haemorrhage: a retrospective single-center study

Hieber,

Lambeck,

Halaby

et al. 2023

Front. Neurol.

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“…Previous studies of endoscopic hematoma removal have reported a hematoma removal rate of 90.3% (87.0%-90.9%) and a rebleeding rate of 3.3% (2.9%-4.0%). 7,11,12,[26][27][28][29][30][31][32] The surgical results in this study were comparable to those previously reported, and the hematoma stiffness was correlated with these results. As expected, group S had more FHR and shorter endoscopic procedure times than group F. Furthermore, both patients whose endoscopic hematoma removal procedure was abandoned belong to group F. Therefore, hematoma stiffness correlates with the surgical results, and predicting hematoma stiffness during endoscopic surgery may help surgeons determine the appropriate treatment strategies.…”

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Clinical Significance of Stiffness during Endoscopic Surgery for Intracerebral Hemorrhage: A Retrospective Study

KISHIDA,

MARUYAMA,

KOTANI

et al. 2023

Neurol. Med. Chir.(Tokyo)

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Studies regarding hematoma stiffness and removal difficulty are scarce. This study explored the association between hematoma stiffness and surgical results of endoscopic hematoma removal for intracerebral hemorrhage. It also aimed to clarify factors associated with hematoma stiffness. We classified intracerebral hematoma as either soft or firm stiffness by retrospectively evaluating operative videos by two neurosurgeons. The interobserver reliability of the classification was assessed by calculating the κ values. We investigated the relationship between hematoma stiffness and surgical results. Favorable hematoma removal (FHR) was defined as a residual hematoma volume of ≤15 mL or removal rate of ≥70%. Furthermore, we compared the background characteristics, imaging findings, and laboratory data between the two groups. Forty patients were included in this study. The mean baseline hematoma volume was 69.9 mL (range, 41.3-97.6 mL). FHR was accomplished in 35 cases (87.5%). Thirty-four patients (85%) were in the soft hematoma group (group S). Six patients (15%) were in the firm hematoma group (group F). Classification of hematoma stiffness demonstrated an excellent degree of interobserver agreement (κ score = 0.91). Patients in group S had a high FHR rate (p = 0.018) and short endoscopic procedure times (p = 0.00034). The island sign was present in group S (p = 0.030). Patients in group F had significantly high fibrinogen levels (p = 0.049) and low serum total calcium (p = 0.032), hemoglobin (p = 0.041), and hematocrit (p = 0.011) levels. Hematoma stiffness during endoscopic surgery for intracerebral hemorrhage correlates with surgical results, including the endoscopic procedure time and accomplishing rate of FHR.

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