Risk factors for mental disorders in patients with hypertensive intracerebral hemorrhage following neurosurgical treatment

A Deep Learning Model for Automatic Segmentation of Intraparenchymal and Intraventricular Hemorrhage for Catheter Puncture Path Planning

Intracerebral hemorrhage is the subtype of stroke with the highest mortality rate, especially when it also causes secondary intraventricular hemorrhage. The optimal surgical option for intracerebral hemorrhage remains one of the most controversial areas of neurosurgery. We aim to develop a deep learning model for the automatic segmentation of intraparenchymal and intraventricular hemorrhage for clinical catheter puncture path planning. First, we develop a 3D U-Net embedded with a multi-scale boundary aware module and a consistency loss for segmenting two types of hematoma in computed tomography images. The multi-scale boundary aware module can improve the model's ability to understand the two types of hematoma boundaries. The consistency loss can reduce the probability of classifying a pixel into two categories at the same time. Since different hematoma volumes and locations have different treatments. We also measure hematoma volume, estimate centroid deviation, and compare with clinical methods. Finally, we plan the puncture path and conduct clinical validation. We collected a total of 351 cases, and the test set contained 103 cases. For intraparenchymal hematomas, the accuracy can reach 96 % when the proposed method is applied for path planning. For intraventricular hematomas, the proposed model's segmentation efficiency and centroid prediction are superior to other comparable models. Experimental results and clinical practice show that the proposed model has potential for clinical application. In addition, our proposed method has no complicated modules and improves efficiency, with generalization ability.

Efficacy of neuroendoscopic surgery versus craniotomy for supratentorial hypertensive intracerebral hemorrhage: A meta-analysis of randomized controlled trials

BACKGROUND

Hypertensive cerebral hemorrhage (HCH) is a potentially life-threatening neurological condition with an extremely high morbidity and mortality. In recent years, neuroendoscopy has been used to treat intracerebral hemorrhage (ICH). However, the choice of neuroendoscopic surgery versus craniotomy for patients with intracerebral hemorrhages is controversial.

AIM

We conducted this meta-analysis to assess the efficacy of neuroendoscopic surgery compared with craniotomy in patients with supratentorial hypertensive ICH.

METHODS

A systematic electronic search was conducted of online electronic databases: PubMed, Embase, and the Cochrane Library updated on December 2017. The meta-analysis only included randomized controlled studies.

RESULTS

Three randomized controlled trials met our inclusion criteria. The pooled analysis of death showed that neuroendoscopic surgery decreased the rate of death when compared with craniotomy (RR = 0.58, 95% CI 0.26-1.29; p = .18). The pooled result of complications indicated that neuroendoscopic surgery has a tendency toward lower complications (RR = 0.37, 95% CI 0.28-0.49; p < .001).

CONCLUSIONS

Our results suggested that neuroendoscopic surgery has lower complications, but no superior advantages in morbidity rates. Since the advantage of neuroendoscopic surgery has been performed in some area, the continuation of multi-center comparative investigation with craniotomy may be necessary. Moreover, some efforts need to be taken in selecting appropriate patients with different treatments.

Effect of rehabilitation therapy and nursing intervention on postoperative recovery of patients with hypertensive intracerebral hemorrhage

Rehabilitation therapy combined with nursing intervention in postoperative recovery of patients with hypertensive intracerebral hemorrhage was investigated. Retrospective analysis was carried out in 78 patients with severe HICH hematoma evacuation after treatment in Xuzhou No. 1 People's Hospital, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University from March 2014 to July 2017. The 28 patients who received routine treatment and nursing care were regarded as the control group, the 27 patients who underwent rehabilitation training based with routine treatment and nursing care were the rehabilitation training group. Moreover, the 23 patients who underwent rehabilitation training and nursing intervention based on routine treatment were regarded as the nursing intervention group. Systolic blood pressure, diastolic blood pressure, and Fugl-Meyer scores were compared immediately after surgery (T1), 4 weeks after treatment (T2) and 12 weeks after treatment (T3). During the period of T3, the total effective rate and adverse reactions were compared among the three groups of patients. The systolic blood pressure and diastolic blood pressure at T3 among the three groups were significantly lower than both T2 and T1, and the systolic and diastolic blood pressure of T2 was lower than T1 (P<0.05). Among the three groups of patients, the Fugl-Meyer score at T3 was significantly higher than both the T2 and T1, and the Fugl-Meyer score at T2 was higher than T1 (P<0.050). In the control group, the number of patients with shoulder-hand syndrome, hemorrhoids, and depression was significantly higher than both the rehabilitation training group and the nursing intervention group (P<0.050). The number of people with depression in the rehabilitation training group was significantly higher than the nursing intervention group (P<0.050). Rehabilitation therapy and nursing intervention are better than routine treatment and nursing for postoperative recovery of HICH patients, and has a lower adverse reaction rates after surgery, it is worthy of promotion clinically.

A Meta-analysis for Evaluating Efficacy of Neuroendoscopic Surgery versus Craniotomy for Supratentorial Hypertensive Intracerebral Hemorrhage

Objective

Hypertensive intracerebral hemorrhage is a potentially life-threatening neurological deficit with the highest morbidity and mortality. In recent years, neuroendoscopy has been used to treat intracerebral hemorrhages (ICHs). However, the choice of neuroendoscopic surgery or craniotomy for patients with ICHs is controversial. The objective of this meta-analysis was to assess the efficacy of neuroendoscopic surgery compared to craniotomy in patients with supratentorial hypertensive ICH.

Materials and Methods

A systematic electronic search was performed using online electronic databases such as Pubmed, Embase, and Cochrane library updated on December 2017. The meta-analysis was performed by only including studies designed as randomized controlled trials.

Results

Three randomized controlled trials met our inclusion criteria. Pooled analysis of death showed that neuroendoscopic surgery decreased the rate of death compared to craniotomy (RR=0.58, 95% CI: 0.26-1.29; P=0.18). Pooled results of complications showed that neuroendoscopic surgery tended to have fewer complications than craniotomy had (RR=0.37, 95% CI: 0.28-0.49; P < 0.0001).

Conclusion

Although the presenting analyses suggest that neuroendoscopic surgery should have fewer complications than craniotomy dose, it had no superior advantage in morbidity rate definitely. Therefore, it may be necessary for the neurosurgeons to select best optimal patients for individual treatment.

The change of Barthel Index scores from the time of discharge until 3-month post-discharge among acute stroke patients in Malaysia: A random intercept model

Background

Acute stroke results in functional disability measurable using the well-known Barthel Index. The objectives of the study are to describe the change in the Barthel Index score and to model the prognostic factors for Barthel Index change from discharge up to 3 months post-discharge using the random intercept model among patients with acute first ever stroke in Kelantan, Malaysia.

Methods

A total 98 in-hospital first ever acute stroke patients were recruited, and their Barthel Index scores were measured at the time of discharge, at 1 month and 3 months post-discharge. The Barthel Index was scored through telephone interviews. We employed the random intercept model from linear mixed effect regression to model the change of Barthel Index scores during the three months intervals. The prognostic factors included in the model were acute stroke subtypes, age, sex and time of measurement (at discharge, at 1 month and at 3 month post-discharge).

Results

The crude mean Barthel Index scores showed an increased trend. The crude mean Barthel Index at the time of discharge, at 1-month post-discharge and 3 months post-discharge were 35.1 (SD = 39.4), 64.4 (SD = 39.5) and 68.8 (SD = 38.9) respectively. Over the same period, the adjusted mean Barthel Index scores estimated from the linear mixed effect model increased from 39.6 to 66.9 to 73.2. The adjusted mean Barthel Index scores decreased as the age increased, and haemorrhagic stroke patients had lower adjusted mean Barthel Index scores compared to the ischaemic stroke patients.

Conclusion

Overall, the crude and adjusted mean Barthel Index scores increase from the time of discharge up to 3-month post-discharge among acute stroke patients. Time after discharge, age and stroke subtypes are the significant prognostic factors for Barthel Index score changes over the period of 3 months.

Relationship between different surgical methods, hemorrhage position, hemorrhage volume, surgical timing, and treatment outcome of hypertensive intracerebral hemorrhage

BACKGROUND

The present study aimed to explore the relationship between surgical methods, hemorrhage position, hemorrhage volume, surgical timing and treatment outcome of hypertensive intracerebral hemorrhage (HICH).

METHODS

A total of 1 310 patients, who had been admitted to six hospitals from January 2004 to January 2008, were divided into six groups according to different surgical methods: craniotomy through bone flap (group A), craniotomy through a small bone window (group B), stereotactic drilling drainage (group C1 and group C2), neuron-endoscopy operation (group D) and external ventricular drainage (group E) in consideration of hemorrhage position, hemorrhage volume and clinical practice. A retrospective analysis was made of surgical timing and curative effect of the surgical methods.

RESULTS

The effectiveness rate of the methods was 74.12% for 1 310 patients after one-month follow-up. In this series, the disability rate was 44.82% 3-6 months after the operation. Among the 1 310 patients, 241 (18.40%) patients died after the operation. If hematoma volume was >80 mL and the operation was performed within 3 hours, the mortality rate of group A was significantly lower than that of groups B, C, D, and E (P<0.05). If hematoma volume was 50-80 mL and the operation was performed within 6-12 hours, the mortality rate of groups B and D was lower than that of groups A, C and E (P<0.05). If hematoma volume was 20-50 mL and the operation was performed within 6-24 hours, the mortality rate of group C was lower than that of groups A, B and D (P<0.05).

CONCLUSIONS

Craniotomy through a bone flap is suitable for patients with a large hematoma and hernia of the brain. Stereotactic drilling drainage is suggested for patients with hematoma volume less than 80 mL. The curative effect of HICH individualized treatment would be improved via the suitable selection of operation time and surgical method according to the position and volume of hemorrhage.