Clinical comparative analysis of stereotactic puncture and drainage of hematoma through frontal parallel white matter fiber tracts and hematoma evacuation under neuroendoscopy in the treatment of basal ganglia intracerebral hemorrhage

doi:10.3877/cma.j.issn.2095-9141.2024.05.007

Abstract

Abstract:

Objective

To compare and analyze the clinical efficacy of stereotactic puncture and drainage of hematoma through frontal parallel white matter fiber and hematoma evacuation under neuroendoscopy in the treatment of basal ganglia intracerebral hemorrhage.

Methods

A total of 45 patients with basal ganglia intracerebral hemorrhage admitted to Neurosurgery Department of Ma’anshan People’s Hospital from June 2020 to April 2024 were collected. According to the treatment method，patients were divided into the stereotactic group （31 patients underwent stereotactic hematoma puncture and drainage via frontal parallel white matter fiber bundle） and the neuroendoscopic group （14 patients underwent endoscopic hematoma removal）. The operation time， intraoperative blood loss， postoperative residual hematoma volume，postoperative brain edema，postoperative activities of daily living （ADL）score and modified Rankin scale （mRS） score，and complications were compared between two groups.

Results

The intraoperative bleeding and postoperative brain edema volume in the stereotactic group were significantly less than those in the neuroendoscopy group， and the hematoma volume at 6 h after surgery was greater than that in the neuroendoscopy group， with statistical significance （P＜0.05）. There was no statistically significant difference in the surgical time， postoperative 3-day hematoma volume，complications， and postoperative rebleeding between two groups （P＞0.05）. The white matter tract protection， ADL score at 1 month after surgery， and mRS score at 3 months after surgery in the stereotactic group were all better than those in the neuroendoscopy group， and the differences were statistically significant （P＜0.05）.

Conclusion

Transfrontal parallel white matter fiber tract stereotactic hematoma puncture and drainage is superior to neuroendoscopic hematoma removal in terms of intraoperative blood loss， postoperative brain edema and prognosis， and can reduce the damage of cerebral white matter fiber tracts.

Key words: Basal ganglia intracerebral hemorrhage, Stereotactic puncture, Neuroendoscopy, White matter fiber tracts

Zhichao Zhang, Chen Li, Hui Han, Xia Zhou, Jiakang Hong. Clinical comparative analysis of stereotactic puncture and drainage of hematoma through frontal parallel white matter fiber tracts and hematoma evacuation under neuroendoscopy in the treatment of basal ganglia intracerebral hemorrhage[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2024, 10(05): 299-303.

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Figures/Tables 4

Tab.1 Comparison of general information between two groups

项目	立体定向组（n=31）	神经内镜组（n=14）	t/χ²值	P值
性别（男/女）	25/6	7/7	3.043	0.081
年龄（岁， $\overset{ˉ}{x}$ ±s）	62.1±11.4	57.6±14.4	1.038	0.311
术前血肿量（mL， $\overset{ˉ}{x}$ ±s）	39.6±4.8	41.0±4.1	0.955	0.345
术前GCS评分（分， $\overset{ˉ}{x}$ ±s）	10.2±1.5	9.5±1.6	1.338	0.193
发病至手术时间（min， $\overset{ˉ}{x}$ ±s）	405.7±46.7	378.7±37.2	1.909	0.063
既往史吸烟饮酒史（有/无）	18/13	8/6	0.003	0.954
发病时出血已经破入脑室（有/无）	10/21	5/9	0.013	0.909

Tab.1 Comparison of general information between two groups

项目	立体定向组（n=31）	神经内镜组（n=14）	t/χ²值	P值
性别（男/女）	25/6	7/7	3.043	0.081
年龄（岁， $\overset{ˉ}{x}$ ±s）	62.1±11.4	57.6±14.4	1.038	0.311
术前血肿量（mL， $\overset{ˉ}{x}$ ±s）	39.6±4.8	41.0±4.1	0.955	0.345
术前GCS评分（分， $\overset{ˉ}{x}$ ±s）	10.2±1.5	9.5±1.6	1.338	0.193
发病至手术时间（min， $\overset{ˉ}{x}$ ±s）	405.7±46.7	378.7±37.2	1.909	0.063
既往史吸烟饮酒史（有/无）	18/13	8/6	0.003	0.954
发病时出血已经破入脑室（有/无）	10/21	5/9	0.013	0.909

Fig.1 Three-dimensional model of hematoma and calculation of edema volume

Tab.2 Comparison of surgical related indicators between two groups

指标	立体定向组（n=31）	神经内镜组（n=14）	Z/χ²值	P值
手术时间[min，M（P₂₅，P₇₅）]	93（67，109）	100（75，109）	-0.540	0.598
术中出血量[mL，M（P₂₅，P₇₅）]	10（8，20）	50（40，100）	-5.031	＜0.001
术后6 h血肿量[mL，M（P₂₅，P₇₅）]	21.8（18.2，25.6）	12.5（9.0，17.0）	4.058	＜0.001
术后3 d血肿量[mL，M（P₂₅，P₇₅）]	10.8（8.2，14.4）	10.4（8.0，17.4）	-0.637	0.534
术后脑水肿体积[mL，M（P₂₅，P₇₅）]	4.1（2.7，6.6）	12.3（10.3，14.4）	-4.647	＜0.001
并发症[例（%）]			1.873	0.171
颅内感染	1（3.2）	1（7.1）
肺部感染	2（6.5）	4（28.6）
术后再出血	1（3.2）	0（0）

Tab.3 Comparison of prognostic indicator between two groups

指标	立体定向组（n=31）	神经内镜组（n=14）	χ²/Z值	P值
术后DTI保护（有/无）	25/6	4/10	9.254	0.002
术后1个月ADL评分[分，M（P₂₅，P₇₅）]	60.0（47.5，70.0）	37.5（26.3，45.0）	3.617	0.003
术后3个月mRS评分[例（%）]			5.993	0.014
≤2分	21（67.7）	4（28.6）
≥3分	10（32.3）	10（71.4）

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