脑中动脉瘤破裂伴脑实质内血肿的初步减压切除术的影响

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie Pub Date : 2025-03-01 DOI:10.1016/j.neuchi.2025.101656

Thomas Metayer , Charles-Henry Mallereau , Charles Peltier , Chloe Dumot , Florian Bernard , Pierre-Jean Le Reste , Anne-Laure Bernat , Helene Cebula , Caroline le Guerinel , Denis Vivien , Michel Piotin , Evelyne Emery , Vianney Gilard , Omer Eker , Roberto Riva , Arthur Leclerc , Elsa Magro , Francois Proust , Isabelle Pelissou-Guyotat , Stephane Derrey , Thomas Gaberel

{"title":"脑中动脉瘤破裂伴脑实质内血肿的初步减压切除术的影响","authors":"Thomas Metayer , Charles-Henry Mallereau , Charles Peltier , Chloe Dumot , Florian Bernard , Pierre-Jean Le Reste , Anne-Laure Bernat , Helene Cebula , Caroline le Guerinel , Denis Vivien , Michel Piotin , Evelyne Emery , Vianney Gilard , Omer Eker , Roberto Riva , Arthur Leclerc , Elsa Magro , Francois Proust , Isabelle Pelissou-Guyotat , Stephane Derrey , Thomas Gaberel","doi":"10.1016/j.neuchi.2025.101656","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Ruptured middle cerebral artery aneurysm (MCAa) with intraparenchymal hematoma (IPH) can benefit at the same time from evacuation of the hematoma and exclusion of the aneurysm of a decompressive craniectomy (DC). To date, there are no clear recommendations for performing a DC in such cases.</div></div><div><h3>Methods</h3><div>We retrospectively collected data from nine French neurosurgical units from January 1, 2013 to December 31, 2020. All MCAa patients with IPH requiring evacuation of the IPH were included in this study. Poor outcomes were defined by an mRs score of 3–6 at 6 months. Propensity score matching was used to analyze the potential effects of DC.</div></div><div><h3>Results</h3><div>Between January 2013 and December 2020, 198 MCAa ruptured with IPH were treated, including 162 MCAa requiring evacuation of the IPH. 50 were treated with DC and 112 without DC. After matching 72 patients, poor neurological prognosis was observed in 27/36 patients (75%) in the DC group versus 18/36 (50%) in the non-DC group (p = 0.026).</div></div><div><h3>Conclusion</h3><div>Primary decompressive craniectomy in patients with ruptured MCAa and IPH requiring surgical evacuation increases the risk of poor neurological outcome. RCT are needed to confirm this hypothesis.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 2","pages":"Article 101656"},"PeriodicalIF":1.5000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The impact of primary decompressive craniectomy in ruptured middle cerebral artery aneurysms with intraparenchymal hematoma\",\"authors\":\"Thomas Metayer , Charles-Henry Mallereau , Charles Peltier , Chloe Dumot , Florian Bernard , Pierre-Jean Le Reste , Anne-Laure Bernat , Helene Cebula , Caroline le Guerinel , Denis Vivien , Michel Piotin , Evelyne Emery , Vianney Gilard , Omer Eker , Roberto Riva , Arthur Leclerc , Elsa Magro , Francois Proust , Isabelle Pelissou-Guyotat , Stephane Derrey , Thomas Gaberel\",\"doi\":\"10.1016/j.neuchi.2025.101656\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Ruptured middle cerebral artery aneurysm (MCAa) with intraparenchymal hematoma (IPH) can benefit at the same time from evacuation of the hematoma and exclusion of the aneurysm of a decompressive craniectomy (DC). To date, there are no clear recommendations for performing a DC in such cases.</div></div><div><h3>Methods</h3><div>We retrospectively collected data from nine French neurosurgical units from January 1, 2013 to December 31, 2020. All MCAa patients with IPH requiring evacuation of the IPH were included in this study. Poor outcomes were defined by an mRs score of 3–6 at 6 months. Propensity score matching was used to analyze the potential effects of DC.</div></div><div><h3>Results</h3><div>Between January 2013 and December 2020, 198 MCAa ruptured with IPH were treated, including 162 MCAa requiring evacuation of the IPH. 50 were treated with DC and 112 without DC. After matching 72 patients, poor neurological prognosis was observed in 27/36 patients (75%) in the DC group versus 18/36 (50%) in the non-DC group (p = 0.026).</div></div><div><h3>Conclusion</h3><div>Primary decompressive craniectomy in patients with ruptured MCAa and IPH requiring surgical evacuation increases the risk of poor neurological outcome. RCT are needed to confirm this hypothesis.</div></div>\",\"PeriodicalId\":51141,\"journal\":{\"name\":\"Neurochirurgie\",\"volume\":\"71 2\",\"pages\":\"Article 101656\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2025-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurochirurgie\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0028377025000293\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurochirurgie","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0028377025000293","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

摘要

背景：脑实质内血肿（IPH）的颅内中动脉动脉瘤（MCAa）破裂可以同时从血肿的清除和减压颅骨切除术（DC）的动脉瘤排除中获益。到目前为止，还没有关于在这种情况下执行DC的明确建议。方法回顾性收集2013年1月1日至2020年12月31日法国9个神经外科单位的资料。所有需要清除IPH的MCAa患者均纳入本研究。不良预后定义为6个月mRs评分为3-6分。倾向评分匹配用于分析DC的潜在影响。结果2013年1月至2020年12月期间，198例MCAa破裂合并IPH，其中162例MCAa需要撤离IPH。DC组50例，未DC组112例。配对72例患者后，DC组有27/36例（75%）患者神经预后较差，非DC组有18/36例（50%）患者预后较差（p = 0.026）。结论MCAa和IPH破裂需要手术清除的患者行一期减压颅脑切除术增加了神经预后不良的风险。需要随机对照试验来证实这一假设。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

The impact of primary decompressive craniectomy in ruptured middle cerebral artery aneurysms with intraparenchymal hematoma

Background

Ruptured middle cerebral artery aneurysm (MCAa) with intraparenchymal hematoma (IPH) can benefit at the same time from evacuation of the hematoma and exclusion of the aneurysm of a decompressive craniectomy (DC). To date, there are no clear recommendations for performing a DC in such cases.

Methods

We retrospectively collected data from nine French neurosurgical units from January 1, 2013 to December 31, 2020. All MCAa patients with IPH requiring evacuation of the IPH were included in this study. Poor outcomes were defined by an mRs score of 3–6 at 6 months. Propensity score matching was used to analyze the potential effects of DC.

Results

Between January 2013 and December 2020, 198 MCAa ruptured with IPH were treated, including 162 MCAa requiring evacuation of the IPH. 50 were treated with DC and 112 without DC. After matching 72 patients, poor neurological prognosis was observed in 27/36 patients (75%) in the DC group versus 18/36 (50%) in the non-DC group (p = 0.026).

Conclusion

Primary decompressive craniectomy in patients with ruptured MCAa and IPH requiring surgical evacuation increases the risk of poor neurological outcome. RCT are needed to confirm this hypothesis.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Neurochirurgie 医学-临床神经学

CiteScore

2.70

自引率

6.20%

发文量

100

审稿时长

29 days

期刊介绍： Neurochirurgie publishes articles on treatment, teaching and research, neurosurgery training and the professional aspects of our discipline, and also the history and progress of neurosurgery. It focuses on pathologies of the head, spine and central and peripheral nervous systems and their vascularization. All aspects of the specialty are dealt with: trauma, tumor, degenerative disease, infection, vascular pathology, and radiosurgery, and pediatrics. Transversal studies are also welcome: neuroanatomy, neurophysiology, neurology, neuropediatrics, psychiatry, neuropsychology, physical medicine and neurologic rehabilitation, neuro-anesthesia, neurologic intensive care, neuroradiology, functional exploration, neuropathology, neuro-ophthalmology, otoneurology, maxillofacial surgery, neuro-endocrinology and spine surgery. Technical and methodological aspects are also taken onboard: diagnostic and therapeutic techniques, methods for assessing results, epidemiology, surgical, interventional and radiological techniques, simulations and pathophysiological hypotheses, and educational tools. The editorial board may refuse submissions that fail to meet the journal''s aims and scope; such studies will not be peer-reviewed, and the editor in chief will promptly inform the corresponding author, so as not to delay submission to a more suitable journal. With a view to attracting an international audience of both readers and writers, Neurochirurgie especially welcomes articles in English, and gives priority to original studies. Other kinds of article - reviews, case reports, technical notes and meta-analyses - are equally published. Every year, a special edition is dedicated to the topic selected by the French Society of Neurosurgery for its annual report.