CT Guided Catheter Aspiration & Thrombolysis of Hypertensive Basal Ganglionic Hematomas: Technique and Short-Term Outcome Comparison CT guided catheter thrombolysis of ICH

Puncture and Drainage Surgery for Intracerebral Hemorrhage Guided by 3D Printing Puncture Guide Plate

OBJECTIVES

Accurate puncture is the key to ensure the effect of puncture and drainage surgery for intracerebral hemorrhage. It usually uses CT to guide the drainage tube to reach the center of the hematoma cavity, which has the problems of inaccurate positioning using 2D images and high requirements for surgeon's experience in brain anatomy and imaging diagnosis. The aim of this study was to use a 3D printing puncture guide plate to guide the puncture and drainage surgery for intracerebral hemorrhage.

METHODS

The CT images were imported into 3D Slicer software to reconstruct 3D models of the head skin and intracerebral hematoma. The target was set in the center of the hematoma and the puncture path from the target to the entry point was designed, the 3D model of puncture guide plate was constructed and saved as stereolithography format file, which was imported into 3D printer to print. During surgery, the drainage tube was placed in the center of the hematoma guided by the 3D printing puncture guide plate, and the blood clot was extracted by the suction syringe.

RESULTS

Eight patients with hypertensive intracerebral hemorrhage were treated with puncture and drainage surgery guided by 3D printing puncture guide plate. The average operation time of the 8 surgeries was 17.63 minutes. The drainage tubes were all precisely placed in the center of the hematoma, and the blood clots were all successfully extracted. The positioning errors of the 8 drainage tubes were between 1.76 mm and 2.68 mm, and the mean value was 2.10±0.32 mm. The hematoma clearance rate of the 8 patients was between 74.18% and 96.73%, and the mean value was 85.14±6.71%.

CONCLUSIONS

The puncture and drainage surgery for intracerebral hemorrhage guided by 3D printing puncture guide plate helps to quickly and effortlessly localize intracerebral hematoma and achieves satisfactory hematoma clearance rate.

Comparison of therapeutic effects of endoscopic assisted different surgical approaches in hypertensive intracerebral hemorrhage: A retrospective cohort study

We aimed to explore the therapeutic effects of endoscopically assisted surgical approaches for HICH. In this retrospective cohort study, we retrospectively analyzed the treatment status of 118 patients with HICH who underwent surgery for hematoma removal. Among them, 61 patients underwent endoscopically assisted hematoma removal surgery through the frontal lobe approach (frontal lobe group); 57 patients underwent endoscopic hematoma assisted via the temporal lobe approach (temporal lobe group). Treatment effects, cerebral hemodynamic status before and after treatment, postoperative prognosis at one month, and incidence of complications were compared between the 2 groups. We found that the total effective treatment rate in the frontal lobe group was higher than that in the temporal lobe group (P < .05). After surgery, the R during the contraction period of the common cerebral artery in both groups decreased compared to that before surgery, and the frontal lobe group was significantly lower than the temporal lobe group; the V and Q were higher than those before surgery, and the frontal lobe group was significantly higher than the temporal lobe group (P < .05). The prognosis of the frontal lobe group was better than that of the temporal lobe group (P < .05). Compared to the endoscopic-assisted temporal approach, the endoscopic-assisted frontal lobe approach for the treatment of HICH can improve cerebral hemodynamic status, enhance treatment efficacy, and improve prognosis.

Minimally invasive puncture combined with a high frequency of urokinase therapy improves outcomes in patients with HICH

Minimally invasive puncture combined with urokinase is widely used in the treatment of hypertensive intracerebral hemorrhage (HICH). However, the appropriate frequency of urokinase following minimally invasive puncture in patients is still unclear. In total, 55 patients were enrolled in this study. According to the frequency of urokinase (10.0 ​× ​104 units) administration, 30 patients received urokinase at Q4h, while the other 25 patients received urokinase at Q8h. In the univariate analysis, preoperative GCS (p ​= ​0.0002), postoperative GCS (p ​= ​0.0007), the volume of residual hematoma (p ​= ​0.0179), and the frequency of urokinase (p ​= ​0.0110) were associated with unfavorable outcomes in patients with HICH in the basal ganglia. The multivariate analysis revealed that the frequency of urokinase was independently associated with unfavorable outcomes in patients with HICH in the basal ganglia (p ​= ​0.038, 1.109-35.380). The drainage time was significantly shorter in the Q4h group (14.17 ​± ​0.86 ​h) than in the Q8h group (27.36 ​± ​1.39 ​h) (p ​< ​0.0001). The GOS (4.37 ​± ​0.18), BI (75.52 ​± ​2.39), and mRS (1.67 ​± ​0.24) in the Q4h group were significantly ameliorated compared to those in the Q8h group (GOS 3.56 ​± ​0.18, BI 64.13 ​± ​2.22, and mRS 2.64 ​± ​0.28, respectively) (p ​= ​0.0004, p ​= ​0.0002, and p ​= ​0.0018) at 3 months of follow-up. Thus, minimally invasive puncture combined with urokinase is safe and efficient. Increasing the frequency of urokinase administration can produce faster and better postoperative recovery for patients with HICH in the basal ganglia.

Clinical Study on a Modified Hematoma Puncture Drainage Treatment in Patients with Hypertensive Basal Ganglia Hemorrhage

OBJECTIVE

We aim to investigate the clinical efficacy and safety of a modified hematoma puncture drainage treatment through the burr hole lateral to Kocher's point from the frontal lobe in patients with hypertensive basal ganglia hemorrhage.

METHODS

Twenty-six patients were enrolled in the retrospective study. The volume of hematoma in those patients was between 25 and 35 mL, and the Glasgow Coma Scale scores were between 9 and 11; they were divided into a hematoma puncture drainage treatment group and a traditional conservative treatment group. The volume of remaining hematoma, neurological function defect scores, and life quality after treatment, duration of hospitalization, and cost of hospitalization were analyzed in these 2 groups.

RESULTS

The volume of remaining hematoma was significantly less in the drainage group than that in the traditional group on the first day and the third day after treatment (P < 0.05). Posttreatment neurological function defect scores in the drainage group were statistically lower than those in the traditional group (P < 0.05). The duration of hospitalization was significantly shorter and the cost of hospitalization was also significantly less in the drainage group than that in the traditional group (P < 0.05). The Extended Glasgow Outcome Scale and Barthel Index scores were significantly higher in the drainage group than those in the traditional group (P < 0.05). There were no significant differences between the 2 groups in the complication rates (P > 0.05).

CONCLUSIONS

The modified hematoma puncture drainage treatment represents an effective and safe way to treat hypertensive basal ganglia hemorrhage.