Individualized surgical management of supratentorial hypertensive intracranial hemorrhage: a retrospective study using 3D Slicer and diffusion tensor imaging.

IF 1.6 3区 医学 Q2 SURGERY
Haifeng Lin, Haiyan Zhao, Jianmin Wang, Enqi Wu, Taiping An
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引用次数: 0

Abstract

Background: This study aims to evaluate the outcomes of individualized surgical interventions tailored to patients with non-traumatic supratentorial intracranial hemorrhage.

Methods: A retrospective cohort study reviewed patients with intracranial hemorrhage who underwent surgical intervention between January 2020 and December 2023. All patients received pre- and post-operative brain computed tomography scans. Three-dimensional (3D) anatomical models of the brain and hematoma were generated using the 3D Slicer software to determine the optimal surgical trajectory in most patients. In addition, some patients underwent magnetic resonance diffusion tensor imaging. Surgical strategies for hematoma evacuation were selected based on each patient's neurological status, hemorrhage location, and hematoma volume. Post-operative neurological function was assessed using the modified Rankin scale.

Results: A total of 196 patients were included in the study. Among them, 97 patients underwent surgical drilling with catheter drainage, 37 patients received small bone window craniotomy with hematoma removal via the Sylvian fissure, 6 patients underwent neuroendoscopic hematoma evacuation, 31 patients received small bone window craniotomy via the cortex, and 25 patients underwent lateral ventricular puncture with drainage. The proportion of patients with an mRS score ≤ 3 was 48.0% at three months and 70.3% at one year post-operatively. Compared with patients who underwent conventional drilling and hematoma drainage, those who received hematoma evacuation guided by 3D Slicer modeling demonstrated better neurological function at three and twelve months post-operatively. Post-operative measurements of the posterior limb of the internal capsule were significantly higher than pre-operative measurements, indicating improved microstructural integrity of white matter tracts and enhanced neurological function. The incidences of post-operative re-bleeding and infection were low, at 2.5% and 1.0%, respectively.

Conclusions: Individualized surgical management, considering patient neurological status, hemorrhage location, and hematoma volume, and utilizing 3D Slicer modeling and diffusion tensor imaging analysis, should be considered for hematoma evacuation in patients with supratentorial intracranial hemorrhage.

幕上高血压性颅内出血的个体化手术治疗:三维切片机和弥散张量成像的回顾性研究。
背景:本研究旨在评估针对非外伤性幕上颅内出血患者的个体化手术干预的结果。方法:一项回顾性队列研究回顾了2020年1月至2023年12月期间接受手术治疗的颅内出血患者。所有患者均接受术前和术后脑计算机断层扫描。使用3D Slicer软件生成脑和血肿的三维(3D)解剖模型,以确定大多数患者的最佳手术轨迹。部分患者行磁共振弥散张量成像。根据每位患者的神经系统状况、出血位置和血肿量选择血肿清除的手术策略。采用改良Rankin评分法评估术后神经功能。结果:共纳入196例患者。其中97例手术钻孔置管引流,37例经Sylvian裂行小骨窗开颅血肿清除术,6例神经内镜下血肿清除术,31例经皮质行小骨窗开颅术,25例行侧脑室穿刺引流术。术后3个月mRS评分≤3分的患者占48.0%,术后1年占70.3%。与常规钻孔和血肿引流的患者相比,在3D切片机建模指导下进行血肿引流的患者在术后3个月和12个月表现出更好的神经功能。术后内囊后肢测量值明显高于术前测量值,表明白质束微结构完整性改善,神经功能增强。术后再出血和感染发生率较低,分别为2.5%和1.0%。结论:幕上颅内出血患者应考虑个体化手术处理,综合考虑患者神经系统状况、出血部位和血肿体积,并利用3D切片机建模和弥散张量成像分析进行血肿清除。
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来源期刊
BMC Surgery
BMC Surgery SURGERY-
CiteScore
2.90
自引率
5.30%
发文量
391
审稿时长
58 days
期刊介绍: BMC Surgery is an open access, peer-reviewed journal that considers articles on surgical research, training, and practice.
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