ABSTRACT
Objective To investigate the technical points and clinical outcomes of frameless stereotactic aspiration in treatment of patients with hypertension cerebral hemorrhage (HPCH). Methods The clinical data of 68 consecutive patients with HPCH, treated with frameless stereotactic aspiration from Jan. 2012 to Jun. 2014, were retrospectively analyzed, and compared to that of 45 patients treated in the meantime by frame-based stereotactic aspiration. The surgical results, procedure-related complications and clinical prognosis were evaluated. Results For the patients treated with frameless stereotactic aspiration, the median age was 53.3 years (range 36-80), the mean initial Glasgow coma scale score was over 5. Among them seven patients died within a month after operation: 3 died of respiratory failure, 2 of cerebral edema and 2 of rehemorrhage. At the six-months followup, the good recovery rate (grade I-III of ADL) was 77.9%(53/68), better than that of patients treated with frame-based stereotactic aspiration (60.0%, P<0.05). Conclusion Frameless stereotactic aspiration for HPCH is easy to operate, minimal invasion and safe procedure with low mortality and rehemorrhage rate.
ABSTRACT
Objectives In this study, the relationships of residue hematoma volume to brain edema and inflammation factors were studied after intracerebral hematoma was evacuated with a frameless stereotactic aspiration. Methods Eighty-nine patients with hypertensive intracerebral hemorrhage (ICH) were treated by frameless stereotactic aspiration. According to residual volume of the hematoma, the patients were divided into gross-total removal of hematoma (GTRH) (≤ 5ml) and sub-total removal of hematoma (STRH) (≥10ml) groups after the operation. The pre-operative and postoperative data of the patients were compared between the two groups. The pre-operative data included age, sex, hematoma volume, time interval from the ictus to the operation, and Glasgow Coma Scale (GCS) scores. The post-operative information included edema grade, level of thromboxane B2 (TXB2), 6-keto-prostaglandin F1α (6-K-PGF1α), tumor necrosis factor-α (TNF-α) and endothelin (ET) in hematoma cavity or cerebral spinal fluid (CSF). Results There were 46 patients in GTRH group and 43 in STRH group respectively. There was no statistical difference in the pre-operative data between the two groups. The levels of TXB2, 6-K-PGF1α, TNF-α and ET were significantly lower in the GTRH group than in the STRH group at different post-operative time points. There was a significant difference between the two groups. The post-operative CT scan at different time points showed that the brain edema grades were better in the GTRH group than in the STRH group. Conclusions GTRH is helpful for decreasing ICH-induced injury to brain tissue, which is related to decreased perihematomal edema formation and secondary injury by coagulation end products activated inflammatory cascade.