ISSN: 1859 - 2872
Functional outcome and prognostic factors in treatment of spontaneous supratentorial intracerebral hemorrhage by navigation guided drainage surgery combined with alteplase
Main Article Content
Keywords
Abstract
Objective: To evaluate the functional outcome (3, 6 and 12 postoperative months) and determine the prognostic factors at 12 postoperative months of navigation guided drainage surgery combined with ateplase for spontaneous supratentorial intracerebral haemorrhage. Subject and method: A prospective study of 80 cases spontaneous supratentorial intracerebral haemorrhage was treated by the frameless stereotactic aspiration of the hematoma plus alteplase at 108 Military Central Hospital. Average age was 55.6 ± 11.4 (28-80), male/female was 4/1. Bleeding in the basal ganglia - thalamus was 73.7%. Result: Functional outcome at 3, 6 and 12 postoperative months were similar, 50% of patients had favorable outcomes (mRS 0-3) while the remaining had poor outcomes (mRS 4-6), including 20 patients died (mRS = 6). Logistic regression analysis by forward stepwise method showed that: age ≥ 65 (OR = 9.933, 95% CI = 1.960-50.331, p=0.006), GCS score before operation ≤ 9 (OR = 5.462, 95% CI = 1.442-20.695; p=0.012), midline shift before operation > 10mm (OR = 17.692, 95% CI = 3.850-81.315; p=0.001) and residual volume of hematoma ≥ 20ml (OR = 8.888, 95% CI = 1.965-40.204, p=0.005) were the significant predictors of a poor 12-month outcome. Conclusion: Navigation guided drainage surgery combined with ateplase improved the rate of favorable outcomes. Age ≥ 65 years, preoperative Glasgow ≤ 9, preoperative midline shift > 10mm and final residual volume of hematoma ≥ 20ml were the significant predictors of a poor 12-month outcome.
Article Details
References
2. Li M, Mu F, Su D, Han Q, Guo Z, Chen T (2020) Different surgical interventions for patients with spontaneous supratentorial intracranial hemorrhage: A network meta-analysis. Clin Neurol Neurosurg 188: 105617.
3. Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G (1993) Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke 24(7): 987-993.
4. Liao CC, Chen YF, Xiao F (2018) Brain midline shift measurement and its automation: A review of techniques and algorithms. Int J Biomed Imaging 2018: 4303161.
5. Graeb DA, Robertson WD, Lapointe JS, Nugent RA, Harrison PB (1982) Computed tomographic diagnosis of intraventricular hemorrhage. Etiology and prognosis. Radiology 143(1): 91-96.
6. Thiex R, Rohde V, Rohde I, Mayfrank L, Zeki Z, Thron A, Gilsbach JM, Uhl E (2004) Frame-based and frameless stereotactic hematoma puncture and subsequent fibrinolytic therapy for the treatment of spontaneous intracerebral hemorrhage. J Neurol 251: 1443-1450.
7. Wang GQ, Li SQ, Huang YH, Zhang WW, Ruan WW, Qin JZ, Li Y, Yin WM, Li YJ, Ren ZJ, Zhu JQ, Ding YY, Peng JQ, Li PJ (2014) Can minimally invasive puncture and drainage for hypertensive spontaneous Basal Ganglia intracerebral hemorrhage improve patient outcome: A prospective non-randomized comparative study. Military Medical Research 1: 10.
8. Wu R, Qin H, Cai Z, Shi J, Cao J, Mao Y, Dong B (2018) The clinical efficacy of electromagnetic navigation-guided hematoma puncture drainage in patients with hypertensive basal ganglia hemorrhage. World Neurosurgery 118: 115-122.
9. Sirh S, Park HR (2018) Optimal surgical timing of aspiration for spontaneous supratentorial intracerebral hemorrhage. J Cerebrovasc Endovasc Neurosurg 20(2): 96-105.
10. Zhang K, Wei L, Zhou X, Yang B, Meng J, Wang P (2022) Risk factors for poor outcomes of spontaneous supratentorial cerebral hemorrhage after surgery. Journal of Neurology: 1-11.
11. Ji R, Shen H, Pan Y, Wang P, Liu G, Wang Y, Li H, Zhao X, Wang Y; China National Stroke Registry (CNSR) investigators (2013) A novel risk score to predict 1-year functional outcome after intracerebral hemorrhage and comparison with existing scores. Crit Care 17(6): 275. doi: 10.1186/cc13130.
Article Sidebar
