Predicting postoperative rehemorrhage in hypertensive intracerebral hemorrhage using noncontrast CT radiomics and clinical data with an interpretable machine learning approach.

In hypertensive intracerebral hemorrhage (HICH) patients, while emergency surgeries effectively reduce intracranial pressure and hematoma volume, their significant risk of causing postoperative rehemorrhage necessitates early detection and management to improve patient prognosis. This study sought to develop and validate machine learning (ML) models leveraging clinical data and noncontrast CT radiomics to pinpoint patients at risk of postoperative rehemorrhage, equipping clinicians with an early detection tool for prompt intervention. The study conducted a retrospective analysis on 609 HICH patients, dividing them into training and external verification cohorts. These patients were categorized into groups with and without postoperative rehemorrhage. Radiomics features from noncontrast CT images were extracted, standardized, and employed to create several ML models. These models underwent internal validation using both radiomics and clinical data, with the best model's feature significance assessed via the Shapley additive explanations (SHAP) method, then externally validated. In the study of 609 patients, postoperative rehemorrhage rates were similar in the training (18.8%, 80/426) and external verification (17.5%, 32/183) cohorts. Six significant noncontrast CT radiomics features were identified, with the support vector machine (SVM) model outperforming others in both internal and external validations. SHAP analysis highlighted five critical predictors of postoperative rehemorrhage risk, encompassing three radiomics features from noncontrast CT and two clinical data indicators. This study highlights the effectiveness of an SVM model combining radiomics features from noncontrast CT and clinical parameters in predicting postoperative rehemorrhage among HICH patients. This approach enables timely and effective interventions, thereby improving patient outcomes.

IV Flat Detector CT Angiography in Flat Detector CT Image-Guided Minimally Invasive Surgery for the Treatment of Intracerebral Hypertensive Hemorrhage.

BACKGROUND AND PURPOSE: Spontaneous intracerebral hemorrhage is a serious stroke subtype with high mortality and morbidity. Minimally invasive surgery plus thrombolysis is a promising treatment option, but it requires accurate catheter placement and real-time monitoring. The authors introduced IV flat detector CT angiography (ivFDCTA) into the minimally invasive surgery procedure for the first time, to provide vascular information and guidance for hematoma evacuation. MATERIALS AND METHODS: Thirty-six patients with hypertensive intracerebral hemorrhage were treated with minimally invasive surgery under the guidance of ivFDCTA and flat detector CT (FDCT) in the angiography suite. The needle path and puncture depth were planned and calculated using software on the DSA workstation. The hematoma volume reduction, operation time, complications, and clinical outcomes were recorded and evaluated. RESULTS: The mean preoperative hematoma volume of 36 patients was 35 (SD, 12) mL, the mean intraoperative volume reduction was 19 (SD, 11) mL, and the mean postoperative residual hematoma volume was 15 (SD, 8) mL. The average operation time was 59 (SD, 22) minutes. One patient had an intraoperative epidural hematoma, which improved after conservative treatment. The mean Glasgow Outcome Scale score at discharge was 4.3 (SD, 0.8), and the mean mRS score at 90 days was 2.4 (SD, 1.1). CONCLUSIONS: The use of ivFDCTA in the evacuation of an intracerebral hemorrhage hematoma could improve the safety and efficiency of minimally invasive surgery and has shown great potential in hemorrhagic stroke management in selected patients.

Aldosteronism is associated with more severe cerebral small vessel disease in hypertensive intracerebral hemorrhage.

Primary aldosteronism is associated with various types of cardiovascular and cerebrovascular damage independently of hypertension. Although chronic hypertension and related cerebral arteriosclerosis are the main risk factors for intracerebral hemorrhage, the effects of aldosteronism remain poorly understood. We enrolled 90 survivors of hypertensive intracerebral hemorrhage, 21 of them with aldosteronism and 69 with essential hypertension as controls in this study. Clinical parameters and neuroimaging markers of cerebral small vessel disease were recorded, and its correlations with aldosteronism were investigated. Our results showed that the aldosteronism group (55.2 ± 9.7 years, male 47.6%) had similar hypertension severity but exhibited a higher cerebral microbleed count (interquartile range) (8.5 [2.0‒25.8] vs 3 [1.0‒6.0], P = 0.005) and higher severity of dilated perivascular space in the basal ganglia (severe perivascular space [number >20], 52.4% vs. 24.6%, P = 0.029; large perivascular space [>3 mm], 52.4% vs. 20.3%, P = 0.010), compared to those with essential hypertension (53.8 ± 11.7 years, male 73.9%). In multivariate models, aldosteronism remained an independent predictor of a higher (>10) microbleed count (odds ratio = 8.60, P = 0.004), severe perivascular space (odds ratio = 4.00, P = 0.038); the aldosterone-to-renin ratio was associated with dilated perivascular space (P = 0.043) and large perivascular space (P = 0.008). In conclusions, survivors of intracerebral hemorrhage with aldosteronism showed a tendency towards more severe hypertensive arteriopathy than the essential hypertension counterparts independently of blood pressure; aldosteronism may contribute to dilated perivascular space around the deep perforating arteries. Aldosteronism is associated with more severe cerebral small vessel disease in hypertensive intracerebral hemorrhage.

Application of 3D visualization technology based on hematoma edge key points setting for emergency hypertensive cerebral hemorrhage surgery in primary hospitals.

OBJECTIVE: This study aims to explore the application potential of 3D visualization technology based in emergency hypertensive cerebral hemorrhage surgery in primary hospitals. The specific goal is to use 3DSlicer software to perform 3D reconstruction and body surface projection on patients with hypertensive cerebral hemorrhage, provide accurate hematoma location information, help surgeons determine the specific location of hematoma on the body surface, and reduce the expansion of surgical incisions. METHODS: 3D reconstruction technology based on 3DSlicer software was employed to process CT images of patients with cerebral hemorrhage. By segmenting and reconstructing the images, a 3D model of the hematoma was generated and projected onto the patient's body surface. Utilizing the functionalities of 3DSlicer software in conjunction with the surgeon's anatomical knowledge, accurate hematoma positioning on the body surface was achieved. RESULTS: 23 patients were enrolled in this study, and underwent successful surgical evacuation. The implementation of 3D visualization technology using 3DSlicer software is expected to provide precise hematoma localization information for emergency hypertensive intracerebral hemorrhage surgery in primary hospitals. This approach will enable surgeons to accurately determine the appropriate surgical incision, thereby minimizing unnecessary trauma and improving the overall success rate of surgery. CONCLUSION: This study demonstrates the potential application of 3D visualization technology based on 3DSlicer software in emergency hypertensive cerebral hemorrhage surgery within primary hospitals. By utilizing 3DSlicer software for hematoma localization, accurate information support can be provided to assist surgeons in managing patients with hypertensive cerebral hemorrhage.

Use of Dyna-computed tomography-assisted neuroendoscopic hematoma evacuation in the treatment of hypertensive intracerebral hemorrhage.

The purpose of this study was to evaluate and summarize the technical characteristics and clinical efficacy of using Dyna-computed tomography (CT)-assisted neuroendoscopic hematoma evacuation to treat hypertensive intracerebral hemorrhage (HICH). We treated 42 consecutive patients with HICH who underwent neuroendoscopic hematoma evacuation in our department from March 1, 2020, to May 31, 2022. Patients were divided into two groups: Dyna-CT-assisted neuroendoscopic group (n = 18) and neuroendoscopic group (n = 24). Retrospective data, treatment efficacy, and outcomes were collected and compared between these two groups. The operative time in the Dyna-CT-assisted neuroendoscopic group was significantly shorter than the operative time in the neuroendoscopic group (mean time 131.6 ± 13.51 vs. 156.6 ± 19.25 min, P < 0.001). Dyna-CT-assisted neuroendoscopic group had significantly less intraoperative blood loss than the neuroendoscopic group (46.94 ± 10.42 vs. 106.46 ± 23.25, P = 0.003). Meanwhile, patients who underwent Dyna-CT-assisted neuroendoscopic had a comparable hematoma clearance rate to those who underwent neuroendoscopic (89.36 ± 7.31 vs. 68.87 ± 19.44%, P = 0.006). The incidence of complications in the Dyna-CT-assisted neuroendoscopic group (5.5%) was lower than in the neuroendoscopic group (12.5%), but the difference was not statistically significant (P = 0.129). Patients who underwent Dyna-CT-assisted neuroendoscopic hematoma evacuation had better 6-month functional outcomes, and the difference was significant (P = 0.004). Furthermore, multivariable analysis showed that younger age, smaller hematoma volume, and Dyna-CT-assisted neuroendoscopic were predictors of favorable 6-month outcomes in HICH patients. In the treatment of HICH, Dyna-CT-assisted hematoma evacuation appears to be safer and more effective than neuroendoscopic hematoma evacuation. Dyna-CT-assisted neuroendoscopic hematoma evacuation in hybrid operating rooms may improve the clinical effect and outcomes of patients with HICH.

Comparison of the Efficacy of Subosseous Window Neuro-Endoscopy and Minimally Invasive Craniotomy in the Treatment of Basal Ganglia Hypertensive Intracerebral Hemorrhage.

OBJECTIVE: To compare the perioperative indexes and long-term effects of craniotomy and neuro-endoscopic hematoma removal in patients with hypertensive intracerebral hemorrhage (HICH) in the basal ganglia region. METHODS: This study involved 128 patients with HICH in the basal ganglia region who were admitted to our hospital from February 2020 to June 2022. They were divided into 2 groups according to the random number table method. The craniotomy group (n = 70) underwent microsurgery with small bone window craniotomy with a side cleft, and the neuro-endoscopy group (n = 58) underwent small bone window neuro-endoscopic surgery. A 3-dimensional Slicer was used to calculate the hematoma volume and clearance rate and the postoperative brain tissue edema volume. The operation time, intraoperative blood loss, postoperative intracranial pressure, complications, mortality, and improvement in the modified Rankin scale score at 6 months postoperatively were compared between the two groups. RESULTS: The clearance rate was significantly higher in the neuro-endoscopy group than in the craniotomy group (94.16% ± 1.86% versus 90.87% ± 1.89%, P < 0.0001). The operation time was significantly lower in the neuro-endoscopy group than in the craniotomy group (89.9 ± 11.7 versus 203.7 ± 57.6 min, P < 0.0001). Intraoperative blood loss was significantly higher in the craniotomy group (248.31 ± 94.65 versus 78.66 ± 28.96 mL, P < 0.0001). The postoperative length of stay in the intensive care unit was 12.6 days in the neuro-endoscopy group and 14.0 days in the craniotomy group with no significant difference ( P = 0.196). Intracranial pressure monitoring showed no significant difference between the two groups on postoperative days 1 and 7. Intracranial pressure was significantly higher in the craniotomy group than in the neuro-endoscopy group on postoperative day 3 (15.1 ± 6.8 versus 12.5 ± 6.8 mm Hg, P = 0.029). There was no significant difference in the mortality or outcome rate at 6 months postoperatively between the two groups. CONCLUSIONS: In patients with HICH in the basal ganglia region, neuro-endoscopy can significantly improve the hematoma clearance rate, reduce intraoperative hemorrhage and postoperative cerebral tissue edema, and improve surgical efficiency. However, the long-term prognosis of patients who undergo craniotomy through the lateral fissure is similar to that of patients who undergo neuro-endoscopic surgery.

The effect of early vs. late CT-guided stereotactic hematoma aspiration on neurological function recovery in patients with hypertensive cerebral hemorrhage in the basal ganglia: a retrospective comparative cohort study.

BACKGROUND: Surgery plays a major role in treating hypertensive cerebral hemorrhage in the basal ganglia; however, some patients suffer from neurological impairment after surgery. Studies have confirmed that stereotactic hematoma aspiration guided by computed tomography (CT) has significant value for patients with hypertensive intracerebral hemorrhage in the basal ganglia, but little is known about the optimal timing for the operation. This study sought to explore the effect of CT-guided stereotactic hematoma aspiration timing on the recovery of neurological function in patients with hypertensive cerebral hemorrhage in the basal ganglia. METHODS: The data of 110 patients with hypertensive cerebral hemorrhage in the basal ganglia admitted to the Union Hospital Tongji Medical College Huazhong University of Science and Technology from January 2021 to December 2021 were retrospectively collected. Based on the timing of their operations, the patients were allocated to the early treatment group (within 24 hours, n=50) and late treatment group (after 24 hours, n=60). The postoperative recovery of the 2 groups was compared. RESULTS: There were no significant differences in terms of age, gender, amount of cerebral hemorrhage, hemorrhage ruptured into ventricle rate, Glasgow Coma Scale score, hypertension grade, hyperlipidemia, diabetes, and operation duration between the 2 groups (P>0.05). Additionally, there was no difference in the preoperative National Institute of Health Stroke Scale scores of the patients in the 2 groups (22.50±4.90 vs. 23.83±5.35, P=0.179). Compared to the late treatment group, the National Institute of Health Stroke Scale score of the patients in the early treatment group was significantly lower 3 and 6 months after the operation (5.90±4.02 vs. 9.23±3.47, P<0.001; 4.54±2.56 vs. 6.50±3.07, P<0.001, respectively). The Glasgow Outcome Scale score of patients in the early treatment group was significantly better than that of patients in the late treatment group (P=0.035). No significant difference was found in the incidence of postoperative pulmonary infection, intracranial infection, rebleeding, and lower extremity deep venous thrombosis between the 2 groups (P>0.05). CONCLUSIONS: Early CT-guided stereotactic hematoma aspiration may improve the postoperative neurological function of patients with hypertensive cerebral hemorrhage in the basal ganglia.

Surgical Navigation System for Hypertensive Intracerebral Hemorrhage Based on Mixed Reality.

Hypertensive intracerebral hemorrhage (HICH) is an intracerebral bleeding disease that affects 2.5 per 10,000 people worldwide each year. An effective way to cure this disease is puncture through the dura with a brain puncture drill and tube; the accuracy of the insertion determines the quality of the surgery. In recent decades, surgical navigation systems have been widely used to improve the accuracy of surgery and minimize risks. Augmented reality- and mixed reality-based surgical navigation is a promising new technology for surgical navigation in the clinic, aiming to improve the safety and accuracy of the operation. In this study, we present a novel multimodel mixed reality navigation system for HICH surgery in which medical images and virtual anatomical structures can be aligned intraoperatively with the actual structures of the patient in a head-mounted device and adjusted when the patient moves in real time while under local anesthesia; this approach can help the surgeon intuitively perform intraoperative navigation. A novel registration method is used to register the holographic space and serves as an intraoperative optical tracker, and a method for calibrating the HICH surgical tools is used to track the tools in real time. The results of phantom experiments revealed a mean registration error of 1.03 mm and an average time consumption of 12.9 min. In clinical usage, the registration error was 1.94 mm, and the time consumption was 14.2 min, showing that this system is sufficiently accurate and effective for clinical application.

When less is more: Non-contrast head CT alone to work-up hypertensive intracerebral hemorrhage.

Hypertension is a common cause of intracerebral hemorrhage (ICH). The work up typically involves neuroimaging of the brain and blood vessels to determine etiology. However, extensive testing may be unnecessary for presumed hypertensive hemorrhages, and instead prolong hospital stay and increase costs. This study evaluates the predictive utility of hemorrhage location on the non-contrast head CT in determining hypertensive ICH. Patients presenting with non-traumatic ICH between March 2014 and June 2019 were prospectively enrolled. Hemorrhage etiology was determined based on previously defined criteria. Chi square and Student's t tests were used to determine the association between patient demographics, ICH severity, neuroimaging characteristics, and medical variables, with hypertensive etiology. Multivariable regression models and an ROC analysis determined utility of CT to accurately diagnose hypertensive ICH. Data on 380 patients with ICH were collected; 42% were determined to be hypertensive. Along with deep location on CT, black race, history of hypertension, renal disease, left ventricular hypertrophy, and higher admission blood pressure were significantly associated with hypertensive etiology, while atrial fibrillation and anticoagulation were associated with non-hypertensive etiologies. Deep location alone resulted in an area under the curve of 0.726. When history of hypertension was added, this improved to 0.771. Additional variables did not further improve the model's predictability. Hypertensive ICH is associated with several predictive factors. Using deep location and history of hypertension alone correctly identifies the majority of hypertensive ICH without additional work-up. This model may result in more efficient diagnostic testing without sacrificing patient care.

3D-Slicer Software-Assisted Neuroendoscopic Surgery in the Treatment of Hypertensive Cerebral Hemorrhage.

OBJECTIVE: To explore the 3D-slicer software-assisted endoscopic treatment for patients with hypertensive cerebral hemorrhage. METHODS: A total of 120 patients with hypertensive cerebral hemorrhage were selected and randomly divided into control group and 3D-slicer group with 60 cases each. Patients in the control group underwent traditional imaging positioning craniotomy, and patients in the 3D-slicer group underwent 3D-slicer followed by precision puncture treatment. In this paper, we evaluate the hematoma clearance rate, nerve function, ability of daily living, complication rate, and prognosis. RESULTS: The 3D-slicer group is better than the control group in various indicators. Compared with the control group, the 3D-slicer group has lower complications, slightly higher hematoma clearance rate, and better recovery of nerve function and daily living ability before and after surgery. The incidence of poor prognosis is low. CONCLUSION: The 3D-slicer software-assisted endoscopic treatment for patients with hypertensive intracerebral hemorrhage has a better hematoma clearance effect, which is beneficial to the patient's early recovery and reduces the damage to the brain nerve of the patient.

Influence of hypertension classification on hypertensive intracerebral hemorrhage location.

The authors sought to explore whether hypertension classification was risk factor for lobar and non-lobar hypertensive intracerebral hemorrhage (HICH) and the prognosis in patients with hematoma. This retrospective cohort study was conducted on HICH patients admitted at the First Affiliated Hospital of Soochow University. Observations with first-ever intracerebral hemorrhage (ICH) were recruited. The authors divided the brain image into three groups according to the location of ICH to predict whether there were significant differences between lobar and non-lobar ICH. A Mann-Whitney U test was used and this retrospective trial also compared the operation and mortality rates. Our cohort included 209 patients (73.7% male; median age:60.5±16.7). The overall incidence of lobar HICH was less than non-lobar HICH (24.4% vs. 68.4%), 7.2% cases of mixed HICH was included in this analysis. In a Mann-Whitney U test analyze, it indicated that there were significant differences in hypertension classification between lobar and non-lobar HICH (Z = -3.3, p<.05). And the percentage of hematoma in lobar areas with relatively slightly high blood pressure (BP) (high normal and grade 1 hypertension) accounts for 52.9% versus 30.1% in non-lobar areas. The increasing trends of the prevalent rate of lobar ICH with BP rising were not remarkable. The non-lobar HICH showed a sharper increase in the condition of grade 3 hypertension compared with lobar HICH. During the period of research, the fatality of lobar hemorrhage was 2.9% versus 7.7% (non-lobar). Besides, the fatality incidence of HICH with relatively slightly high BP (high normal and grade 1 hypertension) was lower than poorly controlled hypertensive patients (grade 2 and grade 3 hypertension). (8.0% vs. 15.7%). The increase of hypertension classification will aggravate the occurrence of non-lobar ICH and positively corrected with BP, but not in lobar areas. It is essential to understand the distinction influence of hypertension classification between lobar and non-lobar ICH.

Association of Satellite Sign with Postoperative Rebleeding in Patients Undergoing Stereotactic Minimally Invasive Surgery for Hypertensive Intracerebral Haemorrhage.

There are few studies regarding imaging markers for predicting postoperative rebleeding after stereotactic minimally invasive surgery (MIS) for hypertensive intracerebral haemorrhage (ICH), and little is known about the relationship between satellite sign on computed tomography (CT) scans and postoperative rebleeding after MIS. This study aimed to determine the value of the CT satellite sign in predicting postoperative rebleeding in patients with hypertensive ICH who undergo stereotactic MIS. We retrospectively examined and analysed 105 patients with hypertensive ICH who underwent standard stereotactic MIS for hematoma evacuation within 72 h following admission. Postoperative rebleeding occurred in 14 of 65 (21.5%) patients with the satellite sign on baseline CT, and in 5 of the 40 (12.5%) patients without the satellite sign. This difference was statistically significant. Positive and negative values of the satellite sign for predicting postoperative rebleeding were 21.5% and 87.5%, respectively. Multivariate logistic regression analysis verified that baseline ICH volume and intraventricular rupture were independent predictors of postoperative rebleeding. In conclusion, the satellite sign on baseline CT scans may not predict postoperative rebleeding following stereotactic MIS for hypertensive ICH.

Establishment and evaluation of a nomogram model for predicting hematoma expansion in hypertensive intracerebral hemorrhage based on clinical factors and plain CT scan signs.

BACKGROUND: Hematoma expansion (HE) is an important risk factor for poor prognosis in patients with hypertensive intracerebral hemorrhage. This study aimed to establish a nomogram model for predicting HE, and evaluate the model. METHODS: The clinical data and plain computed tomography (CT) scan signs of 341 patients with hypertensive intracerebral hemorrhage were retrospectively analyzed. According to the development of HE, the patients were divided into an HE group (100 cases) and a non-HE group (241 cases). The clinical data and CT scan signs of the patients in these two groups were compared. Variables that had statistically significant differences were included in the multivariate logistic regression analysis to screen for independent predictors of HE and establish a nomogram model. The discrimination, calibration, and clinical practicability of this model were evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and a decision curve analysis (DCA), respectively. Finally, the internal validation of this model was performed using the bootstrap method. RESULTS: The time interval from disease onset to the first CT [odds ratio (OR) =0.807, 95% confidence interval (CI): 0.665-0.979], volume of the hematoma at the first CT (OR =1.017, 95% CI: 1.001-1.033), irregular shape of the hematoma (OR =2.458, 95% CI: 1.355-4.456), swirl sign (OR =2.308, 95% CI: 1.239-4.298), and blend sign (OR =2.509, 95% CI: 1.304-4.830) were independent predictors of HE (all P<0.05). These factors were used to establish a nomogram model. The area under the ROC curve of the model was 0.762 (95% CI: 0.703-0.821). The results of the Hosmer-Lemeshow test and calibration curves showed that the predictive probabilities of the model fit the actual probabilities well. The DCA results showed that the domain probability range of the model was wide. The internal validation results showed that the C-index was 0.751, and the model's discrimination was good. CONCLUSIONS: The nomogram model established in this study had good discrimination, calibration, and clinical practicability. The model could serve as an intuitive and reliable guiding tool for the clinical identification of HE risk of hypertensive intracerebral hemorrhage.

Asymptomatic Striatocapsular slit-like Hemorrhage as a Severity Marker in Patients with Hypertensive Angiopathy.

BACKGROUND: Concomitant asymptomatic striatocapsular slit-like hemorrhage (SSH) is occasionally found in patients of spontaneous intracerebral hemorrhage (ICH), but was seldomly described in the literature. In this study, we described the clinico-radiological features of asymptomatic SSH in ICH patients with hypertensive microangiopathy. METHODS AND RESULTS: 246 patients with strictly deep or mixed deep and lobar ICH/microbleeds were included. SSH was defined as hypointense lesions involving the lateral aspect of lentiform nucleus or external capsule in slit shape (>1.5 cm) on susceptibility-weighted imaging without history of associated symptoms. Demographics and neuroimaging markers were compared between patients with SSH and those without. Patients with SSH (n=24, 10%) and without SSH had comparable age (62.0 ± 12.6 vs. 62.3 ± 13.5, p = 0.912) and vascular risk factor profiles including the diagnosis of chronic hypertension, diabetes, and dyslipidemia (all p>0.05). SSH was associated with more common lobar microbleeds (79.2% vs 48.2%, p = 0.005), lacunes (75% vs. 41.4%, p = 0.002) and higher white matter hyperintensity (WMH) volumes (24.1 [10.4-46.3] vs. 13.9 [7.0-24.8] mL, p = 0.012) on MRI, as well as more frequent left ventricular hypertrophy (LVH) (50.0% vs. 20.5%, p = 0.004) and albuminuria (41.7% vs. 19.4%, p = 0.018). In multivariable analyses, SSH remains independently associated with LVH (p = 0.017) and albuminuria (p = 0.032) after adjustment for age, sex, microbleed, lacune and WMH volume. CONCLUSIONS: Asymptomatic SSH is associated with more severe cerebral small vessel disease-related change on brain MRI, and hypertensive cardiac and renal injury, suggesting a more advanced stage of chronic hypertension.

Lower total protein and absence of neuronavigation are novel poor prognostic factors of endoscopic hematoma removal for intracerebral hemorrhage.

OBJECTIVES: Endoscopic hematoma removal is widely performed for the treatment of intracerebral hemorrhage. We investigated the factors related to the prognosis of intracerebral hemorrhage after endoscopic hematoma removal. MATERIALS AND METHODS: From 2013 to 2019, we retrospectively analyzed 75 consecutive patients with hypertensive intracerebral hemorrhage who underwent endoscopic hematoma removal. Their characteristics, including neurological symptoms, laboratory data, and radiological findings were investigated using univariate and multivariate analysis. Complications during hospitalization, Glasgow Coma Scale (GCS) score on day 7, and modified Rankin Scale (mRS) score at 6 months were considered as treatment outcomes. RESULTS: The mean age of the patients (33 women, 42 men) was 71.8 (36-95) years. Mean GCS scores at admission and on day 7 were 10.3 ± 3.2 and 11.7 ± 3.8, respectively. The mean mRS score at 6 months was 3.8 ± 1.6, and poor outcome (mRS score ranging from 3 to 6 at 6 months) in 53 patients. Rebleeding occurred in 4 patients, and other complications in 15 patients. Multivariate analysis revealed that older age, hematoma in the basal ganglia, lower total protein level, higher glucose level, and absence of neuronavigation were associated with poor outcomes. Of the 75 patients, 9 had cerebellar hemorrhages, and they had relatively favorable outcomes compared to those with supratentorial hemorrhages. CONCLUSION: Several factors were related to the prognosis of intracerebral hemorrhage after endoscopic hematoma removal. Lower total protein level at admission and absence of neuronavigation were novel factors related to poor outcomes of endoscopic hematoma removal for intracerebral hemorrhage.

Endoscopic Surgery versus Minimal Puncture Drainage Surgery for Treatment of Supratentorial Intracerebral Hemorrhage.

AIM: To compare neuroendoscopy versus minimal puncture drainage for surgical treatment of supratentorial hypertensive intracerebral hemorrhage. MATERIAL AND METHODS: A total of 108 cases involving supratentorial intracerebral hemorrhage were retrospectively analyzed. In 30 cases, endoscopic surgery was performed, while 78 cases involved puncture surgery. We compared hematoma clearance rate, postoperative rebleeding rate, incidence of postoperative complications, operation duration, and Glasgow coma score seven days after surgery. Clinical data such as early postoperative rehabilitation time, Glasgow outcome score three months after surgery, and intensive care unit (ICU) stay were also compared between the two groups. RESULTS: The results showed that endoscopic surgery was associated with a superior clinical therapeutic effect in hematoma clearance rates, GCS scores on postoperative day 7, the average ICU stay, early postoperative rehabilitation time and intracranial infection outcomes than minimal puncture drainage surgery for the treatment of supratentorial intracerebral hemorrhage (p < 0.05). Three months after surgery, the favorable prognosis rate in the endoscopic treatment group was significantly higher than that in the craniotomy group [83.3% (28/34) vs. 61.5% (31/51), respectively; ? < sup > 2 < /sup > =4.698, p=0.030]. In contrast, no significant differences in rebleeding, pulmonary infection, tracheotomy, secondary epilepsy, gastrointestinal hemorrhage, death in late postoperative period, or in baseline parameters were observed between the two groups (p > 0.05). CONCLUSION: Endoscopic surgery potentially represents a beneficial surgical procedure for treatment of supratentorial spontaneous intracerebral hemorrhage.

Arrival blood pressure in hypertensive and non-hypertensive spontaneous intracerebral hemorrhage.

BACKGROUND AND PURPOSE: Hypertension is a known risk factor for intracerebral hemorrhage (ICH), but it is unclear whether blood pressure (BP) at hospital arrival can be used to distinguish hypertensive ICH from non-hypertensive etiologies. PATIENTS AND METHODS: We performed a single-center cohort study using data from consecutive ICH patients over 12 months. ICH characteristics including etiology were prospectively adjudicated by two attending neurologists. Using adjusted linear regression models, we compared first recorded systolic BPs (SBP) and mean arterial pressures (MAP) in patients with hypertensive vs. other ICH etiologies. We then used area under the ROC curve (AUC) analysis to determine the accuracy of admission BP in differentiating between hypertensive and non-hypertensive ICH. RESULTS: Of 311 patients in our cohort (mean age 70.6 ± 15.6, 50% male, 83% white), the most frequent ICH etiologies were hypertension (50%) and cerebral amyloid angiopathy (CAA; 22%). Mean SBP and MAP for patients with hypertensive ICH was 175.1 ± 32.9 mmHg and 120.4 ± 22.9 mmHg, respectively, compared to 156.4 ± 28.0 mmHg and 109.6 ± 20.3 mmHg in non-hypertensive ICH (p < .001). Adjusted models showed that hypertensive ICH patients had higher BPs than those with CAA (mean SBP difference 10.7 mmHg [95% CI 0.8-20.5]; mean MAP difference 8.1 mmHg [1.1-15.0]) and especially patients with other non-CAA causes (mean SBP difference 23.9 mmHg [15.3-32.4]; mean MAP difference 14.5 mmHg [8.5-20.6]). However, on a patient-level, arrival BP did not reliably discriminate between hypertensive and non-hypertensive etiologies (AUC 0.660 [0.599-0.720]). CONCLUSIONS: Arrival BP differs between hypertensive and non-hypertensive ICH but should not be used as a primary determinant of etiology, as hypertension may be implicated in various subtypes of ICH.