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Surgical strategy for patients with supratentorial spontaneous intracerebral hemorrhage: minimally invasive surgery and conventional surgery

대한뇌혈관외과학회지 2020년 22권 3호 p.156 ~ 164
Jang Je-Hun, 조원상, Hong No-Ah, Pang Chang-Hwan, 이성호, 강현승, 김정은,
소속 상세정보
 ( Jang Je-Hun ) - Seoul National University College of Medicine Seoul National University Hospital Department of Neurosurgery
조원상 ( Cho Won-Sang ) - Seoul National University College of Medicine Seoul National University Hospital Department of Neurosurgery
 ( Hong No-Ah ) - Seoul National University College of Medicine Seoul National University Hospital Department of Neurosurgery
 ( Pang Chang-Hwan ) - Seoul National University College of Medicine Seoul National University Hospital Department of Neurosurgery
이성호 ( Lee Sung-Ho ) - Seoul National University College of Medicine Seoul National University Hospital Department of Neurosurgery
강현승 ( Kang Hyun-Seung ) - Seoul National University College of Medicine Seoul National University Hospital Department of Neurosurgery
김정은 ( Kim Jeong-Eun ) - Seoul National University College of Medicine Seoul National University Hospital Department of Neurosurgery

Abstract


Objective: The role of surgery in spontaneous intracerebral hemorrhage (sICH) is still controversial. We aimed to investigate the effectiveness of minimally invasive surgery (MIS) compared to conventional surgery (CS) for supratentorial sICH.

Methods: The medical data of 70 patients with surgically treated supratentorial sICH were retrospectively reviewed. MIS was performed in 35 patients, and CS was performed in 35 patients. The surgical technique was selected based on the neurological status and radiological findings, such as hematoma volume, neurological status and spot signs on computed tomographic angiography. Treatment outcomes, prognostic factors and the usefulness of the spot sign were analyzed.

Results: Clinical states in both groups were statistically similar, preoperatively, and in 1 and 3 months after surgery. Both groups showed significant progressive improvement till 3 months after surgery. Better preoperative neurological status, more hematoma removal and intensive care unit (ICU) stay ≤7 days were the significant prognostic factors for favorable 3-month clinical outcomes (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.10-0.96, p=0.04; OR 1.04, 95% CI 1.01-1.08, p=0.02; OR 26.31, 95% CI 2.46-280.95, p=0.01, respectively). Initial hematoma volume and MIS were significant prognostic factors for a short ICU stay (≤7 days; OR 0.95; 95% CI 0.91-0.99; p=0.01; OR 3.91, 95% CI 1.03-14.82, p=0.045, respectively). No patients in the MIS group experienced hematoma expansion before surgery or postoperative rebleeding.

Conclusions: MIS was not inferior to CS in terms of clinical outcomes. The spot sign seems to be an effective radiological marker for predicting hematoma expansion and determining the surgical technique.

키워드

Conventional surgery; Intracerebral hemorrhage; Minimally invasive surgery; Spot sign; Treatment outcome

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