微创术后自发性小脑出血患者术前血肿周围水肿的预后意义。

IF 3.1 3区医学 Q2 CLINICAL NEUROLOGY

Neurocritical Care Pub Date : 2025-06-01 Epub Date: 2025-02-26 DOI:10.1007/s12028-025-02221-4

Haixiao Liu, Dongbo Li, Yaning Cai, Longlong Zheng, Zhijun Tan, Feng Liu, Fei Gao, Hui Zhang, Yong Du, Gaoyang Zhou, Feifei Sun, Ruixi Fan, Ping Wang, Lei Wang, Shunnan Ge, Tianzhi Zhao, Tao Zhang, Rongjun Zhang, Guoqiang Xie, Yan Qu, Wei Guo

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引用次数: 0

摘要

背景：微创手术（MIS）已广泛应用于自发性小脑出血（SCH）患者，包括内镜下引流术和微创导管（MIC）引流术。然而，长期预后差异很大。本研究采用一项多中心队列病例对照研究，探讨MIS术后SCH患者不良预后的危险因素。方法：收集观察患者的病史、围手术期计算机断层扫描及6个月预后资料。比较预后良好（改良Rankin量表评分≤3分）和预后不良（改良Rankin量表评分≥4分）患者的这些变量，探讨预后预测因素。结果：来自4个临床中心的80例患者被纳入本研究。高龄、MIC清除、术后大血肿周围水肿（PHE）和术前大血肿（PHE） 4个因素被确定为6个月不良神经预后的独立危险因素。随后的分析表明，术前PHE是6个月时不良神经预后的可靠预测因子（曲线下面积= 0.849）。基于限制性三次样条分析，患者随后被分为术前大PHE（≥10 ml）亚组和术前小PHE(结论：高龄、MIC清除、术前大PHE和术后大PHE是行MIS的SCH患者不良预后的独立因素。值得注意的是，术前大PHE是不良长期神经预后的独立预测因子，特别是当术前PHE≥10 ml时。

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Prognostic Significance of Preoperative Perihematomal Edema in Spontaneous Cerebellar Hemorrhage After Minimally Invasive Surgery.

Background: Minimally invasive surgery (MIS), including endoscopic evacuation and minimally invasive catheter (MIC) evacuation, has been widely used in patients with spontaneous cerebellar hemorrhage (SCH). However, the long-term prognosis varies widely. Herein, a case-control study nested within a multicenter cohort was conducted to explore the risk factors for unfavorable prognosis in patients with SCH after MIS.

Methods: The data on medical history, perioperative computed tomography scans, and 6-month prognosis of the observed patients were collected. A comparison of these variables between patients with favorable outcomes (modified Rankin Scale score ≤ 3) and those with unfavorable outcomes (modified Rankin Scale score ≥ 4) was conducted to investigate prognostic predictors.

Results: Eighty patients from four clinical centers were enrolled in the present study. Four factors including advanced age, MIC evacuation, large postoperative perihematomal edema (PHE), and large preoperative PHE were identified as independent risk factors for 6 month unfavorable neurological outcome. Subsequent analysis demonstrated that preoperative PHE serves as a reliable predictor of unfavorable neurological outcome at 6 months (area under the curve = 0.849). Based on restricted cubic spline analysis, patients were subsequently stratified into a large preoperative PHE (≥ 10 ml) subgroup and a small preoperative PHE (< 10 ml) subgroup. The incidence of unfavorable outcomes in the large preoperative PHE subgroup (47.4%) was significantly higher than that in the small preoperative PHE subgroup (2.4%).

Conclusions: Advanced age, MIC evacuation, large preoperative PHE, and postoperative PHE are independent factors associated with unfavorable outcome in patients with SCH who underwent MIS. Significantly, the large preoperative PHE is an independent predictor for unfavorable long-term neurological outcome, particularly when the preoperative PHE is ≥ 10 ml.

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来源期刊

Neurocritical Care 医学-临床神经学

CiteScore

7.40

自引率

8.60%

发文量

221

审稿时长

4-8 weeks

期刊介绍： Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.