The incidence, mortality, and disability rate of spontaneous intracerebral hemorrhage (SICH) are high, and its surgical and medical treatment is still controversial. With the development of micro-neurosurgical technology, minimally invasive surgery (MIS) has made great progress in the treatment of SICH. It can remove intracerebral hematoma in the early stage after SICH and minimize or eliminate secondary brain injury, which is of great significance to reducing the mortality and disability rate. For many years, due to its continuous progress, MIS has been more and more widely used in the treatment of SICH. This article mainly reviews the progress of MIS in SICH and related clinical research at home and abroad, and briefly describes several innovative techniques related to MIS, which aims to promote the exchange of clinical experience in MIS of SICH.
ObjectivesTo explore the efficacy and prognostic factors of neuroendoscopic intracerebral hematoma evacuation in the treatment of hypertension-related intracerebral hemorrhage.MethodsA total of 122 patients with hypertension-related intracerebral hemorrhage treated in our hospital from October 2015 to May 2019 were categorized into experimental group (n=62) and control group (n=60). The experimental group was treated with endoscopic intracerebral hematoma removal, while the control group was treated with traditional craniotomy. The operative indexes, postoperative recovery, serum endothelin, IL-6, CRP levels and the incidence of postoperative complications were observed and compared between the two groups, and the relevant factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation were analyzed.ResultsThe operation time, intraoperative blood loss, hematoma clearance rate, ICU treatment time, the volume of brain edema 7 days after operation, the postoperative intracranial pressure, NIHSS score and ADL score in experimental group were significantly superior to those in control group. The levels of serum endothelin, IL-6 and CRP in the experimental group were significantly lower than those in the control group after operation. The incidence of complications in the experimental group was lower than that in control group. Univariate analysis showed that the prognosis of patients undergoing neuroendoscopic evacuation of intracerebral hematoma was significantly correlated with the history of hypertension, preoperative GCS score, the amount of bleeding and whether been broken into the ventricle (P<0.05), but not with age, sex and location of hemorrhage (P>0.05). Multivariate logistic regression analysis showed that the history of hypertension above 10 years, blood loss above 50 mL, intraventricular rupture and preoperative GCS score were the risk factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation.ConclusionsCompared with traditional craniotomy, neuroendoscopic evacuation of intracerebral hematoma has the advantages of better curative effect and lower incidence of postoperative complications in the treatment of hypertension-related intracerebral hemorrhage. The history of hypertension above 10 years, bleeding volume above 50 mL, breaking into the ventricle and preoperative GCS score are the risk factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation.
ObjectiveTo explore and compare the therapeutic effects of neuro-endoscopic and craniotomic hematoma evacuation for hypertensive hematomas in the basal ganglia region. MethodsEighty-six patients with hypertensive hematomas in the basal ganglia regions treated between January 2010 and September 2014 were divided into neuro-endoscopy and craniotomy groups randomly with 43 in each. Hematoma was removed directly under neuro-endoscope in the endoscopic group, while it was removed under the operating microscope in the craniotomy group. The average operation bleeding amount, residual hematoma after operation, hematoma evacuation rate, the changes of National Institutes of Health Stroke Scale (NIHSS) and Barthel index (BI) scores before operation, 1 and 3 months after operation were compared between the two groups. All data were analyzed statistically. ResultsThe average amount of operation bleeding was (127±26) mL, postoperative residual hematoma was (6±4) mL, and the hematoma clearance rate was (86±9)% in the neuro-endoscopy group, while those three numbers in the craniotomy group were respectively (184±41) mL, (11±6) mL, and (72±8)%, with all significant differences (P < 0.05). The NIHSS and BI scores were not significantly different between the two groups before surgery (P > 0.05). Seven days, one month and three months after surgery, the NIHSS score was significantly lower, and the BI score was significantly higher in the neuro-endoscopy group than the craniotomy group (P < 0.05). ConclusionNeuro-endoscopic surgery for hypertensive hematomas in basal ganglia region is proved to have such advantages as mini-invasion, direct-vision, complete clearance and good neural function recovery after surgery, which is a new approach in this field.
ObjectiveTo study the brain tissue oxygen and prognosis index of the postoperative patients with hypertensive intracerebral hemorrhage (HICH) associated with secondary brain insults. MethodsA total of 120 patients with HICH from January 2006 to June 2013 were treated by neurosurgical intervention. Postoperative monitoring of factors affecting the secondary brain insults in the 120 patients and of brain tissue oxygen in 10 patients was performed and statistically analysis was carried out. ResultsSecondary brain insults had a significant influence on the prognosis of postoperative patients with hypertensive intracerebral hemorrhage, and was correlated with brain tissue oxygen metabolism. ConclusionAbnormal secondary brain insults affect brain tissue oxygen metabolism, which may further deteriorate the brain damage and can lead to poor prognosis.
This study was aimed to improve the sensitivity of magnetic induction phase shift detection system for cerebral hemorrhage. In the study, a cerebral hemorrhage model with 13 rabbits was established by injection of autologous blood and the cerebral hemorrhage was detected by utilizing magnetic induction phase shift spectroscopy (MIPSS) detection method under the feature band. Sixty five groups of phase shift spectroscopy data were obtained. According to the characteristics of cerebral hemorrhage phase shift spectroscopy under the feature band, an effective method, B-F distribution, to diagnose the severity of cerebral hemorrhage was designed. The results showed that using MIPSS detection method under feature band, the phase shift obviously growed with increase of injection volume of autologous blood, and the phase shift induced by a 3-mL injection reached-7.750 3°±1.420 4°. B-F distribution could effectively diagnose the severity of cerebral hemorrhage. It can be concluded that the sensitivity of the cerebral hemorrhage magnetic induction detection system is improved by one order of magnitude with the MIPSS detection method under the feature band.
Objective To analyze the value of serum levels of miR-141-3p, miR-130a, miR-29a-3p, and miR-210 in predicting early neurological deterioration (END) in non-traumatic intracerebral hemorrhage. Methods The patients with non-traumatic cerebral hemorrhage who met the selection criteria and were admitted to Chengde Central Hospital between February 2021 and October 2022 were prospectively selected by convenience sampling method. The serum miR-141-3p, miR-130a, miR-29a-3p, and miR-210 levels upon admission and the occurrence of neurological deterioration within 24 h were collected, and the patients were divided into a deterioration group and a non-deterioration group according to whether neurological deterioration occurred. The correlation of serum miR-141-3p, miR-130a, miR-29a-3p, and miR-210 levels with the END of non-traumatic intracerebral hemorrhage and their predictive value to the END of non-traumatic intracerebral hemorrhage were analyzed. Results A total of 235 patient were enrolled. Of the 235 patients, 45 (19.1%) showed neurological deterioration and 190 (80.9%) showed no neurological deterioration. The levels of miR-141-3p and miR-29a-3p in the deteriorating group were significantly lower than those in the non-deteriorating group [(1.11±0.32) vs. (1.76±0.51) ng/mL, P<0.001; (1.19±0.31) vs. (1.71±0.51) ng/mL, P<0.001], and the levels of miR-130a and miR-210 were significantly higher than those in the non-deteriorating group [(5.13±1.11) vs. (3.82±1.03) ng/mL, P<0.001; (3.96±0.76) vs. (2.78±0.50) ng/mL, P<0.001]. Multivariate logistic regression analysis showed that serum miR-141-3p and miR-29a-3p levels were protective factors for the occurrence of END in non-traumatic intracerebral hemorrhage patients [odds ratio (OR)=0.513, 95% confidence interval (CI) (0.330, 0.798), P=0.003; OR=0.582, 95%CI (0.380, 0.893), P=0.013], and serum miR-130a and miR-210 levels were independent risk factors for that [OR=2.046, 95%CI (1.222, 3.426), P=0.007; OR=2.377, 95%CI (1.219, 4.638), P=0.011]. The area under the receiver operating characteristic curve was 0.857 [95%CI (0.760, 0.954)] in predicting the END of non-traumatic intracerebral hemorrhage by the combined probability of the serum miR-141-3p, miR-130a, miR-29a-3p, and miR-210 levels obtained by logistic regression, and the sensitivity was 86.7%, the specificity was 94.7%, the positive predictive value was 79.6%, and the negative predictive value was 96.8% according to the cut-off value of the prediction probability of the combined test. Conclusion The combined detection of serum miR-141-3p, miR-130a, miR-29a-3p, and miR-210 has a high predictive value in the occurrence of END in non-traumatic intracerebral hemorrhage patients.
Resuming oral anticoagulant (OAC) after intracerebral hemorrhage (ICH) is still a dilemma to clinical decision. To date, no high-quality randomized controlled trials demonstrate the timing and mode of safely resuming OAC. In recent years, some moderate-quality researches have suggested that OAC resuming after ICH can decrease the incidence of thromboembolic events and long-term mortality, without significantly increasing the risk of ICH; it is safer to resuming OAC in patients with non-lobar ICH than in patients with lobar-ICH; new OACs are superior to vitamin K antagonists; patients with high thromboembolic risk should resume OAC 2 weeks or even earlier after ICH, otherwise, a time-window for optimal resumption is between 4-8 weeks; meanwhile, individual patient characteristics should be considered and blood pressure should be strictly controlled.
ObjectiveTo explore the influencing factors for the prognosis of intracerebral hemorrhage in extremely old patients. MethodsWe retrospectively analyzed the clinical data of 104 extremely old intracerebral hemorrhage patients (≥80 years old) treated between June 2010 and June 2013. According to Glass Outcome Score, the patients were divided into good outcome group (with a score of 4-5) and poor outcome group (with a score of 1-3). The age, gender, consciousness on admission, mean arterial pressure, systolic blood pressure on admission, and complication rate were analyzed and compared between the two groups of patients. ResultsA total of 104 patients were recruited in our study, with 62 in the good outcome group and 42 in the poor outcome group. The gender, age, average arterial pressure on admission between the two groups were not significantly different (P>0.05). The consciousness score at admission in the good outcome group (13.79±2.38) was significantly higher than that of the poor outcome group (8.24±3.80, P<0.05). The complication rate (45.2% vs. 88.1%) and systolic blood pressure on admission [(168.87±25.03) vs. (181.83±29.82) mm Hg (1 mm Hg=0.133 kPa] in the good outcome group were both significantly lower than those in the poor outcome group (P<0.05). ConclusionFor extremely old intracerebral hemorrhage patients, consciousness score and systolic blood pressure at admission, and complication rate are the influencing factors for the prognosis. In addition, a systolic pressure on admission above 180 mm Hg can be a risk factor for poor prognosis in extremely old patients.
Objective To analyze the trends in the burden of intracerebral hemorrhage (ICH) and its related risk factors in China from 1990 to 2021, providing evidence for targeted prevention and control. Methods Based on public data from the Global Burden of Disease Study 2021, four epidemiological indicators, including incidence, prevalence, deaths, and disability-adjusted life-years (DALYs) were selected to describe the burden of ICH in China in 2021. Change rates and estimated annual percentage changes (EAPC) were calculated to evaluate the trends in disease burden from 1990 to 2021. The Das Gupta method was used to decompose the effects of population growth, population aging and epidemiological changes on the burden during this period. Finally, the attributable burden of risk factors related to ICH was analyzed. Results In 2021, the age-standardized incidence, prevalence, mortality, and DALY rates of ICH in China were 61.2/100000, 222.1/100000, 68.8/100000, and 1351.6/100000, respectively, all higher than global estimates. From 1990 to 2021, although these rates showed a declining trend (EAPC: −2.24, −1.26, −2.38, and −2.47, respectively), the absolute disease burden, including the absolute number of incidence cases, prevalence cases, deaths, and DALYs, continued to rise, with an increase ranging from 20.57% to 51.59%. In addition, the burden of ICH in China varied by age and sex, with older adults and males experiencing a higher burden. Decomposition analysis indicated that population aging and growth were the primary drivers of the increasing ICH burden in China, while epidemiological changes mitigated this trend. Metabolic factors were the predominant attributable risk factors for ICH. High systolic blood pressure, ambient particulate matter pollution, and diet high in sodium were important risk factors common to both genders. The DALY burden attributable to smoking and alcohol use was higher in men, whereas impaired kidney function and secondhand smoke had a greater impact on women. Conclusions The burden of ICH in China has continued to increase from 1990 to 2021, and it may further escalate in the context of population aging. Risk factor control remains a key priority for prevention. Future strategies should incorporate age- and sex-specific interventions to reduce the ICH burden in China.
摘要:目的:动态观察大鼠脑出血后血肿周围组织补体激活与细胞凋亡的规律。方法:用胶原酶注入到大鼠尾状核的方法制作脑出血模型。将大鼠分为脑出血、假手术组、正常组3组。采用苏木素伊红(HE) 染色、免疫组织化学染色及原位末端脱氧核苷酸转移酶介导的dUTP 缺口末端标记法(TUNEL)分别观察各组在脑出血后第6 h、12 h、24 h、48 h、72 h、5 d、7 d时血肿周围补体C3、促凋亡基因(Bax)、抑凋亡基因(Bclxl)及TUNEL的表达。结果补体C3的表达峰值在24~48 h;TUNEL、Bax蛋白表达术后12h增加,48~72 h达高峰,而Bclxl蛋白表达高峰在48h。结论:大鼠脑出血后血肿周围组织补体C3的表达增加与细胞凋亡的演变趋势一致,C3与凋亡有相关。Abstract: Objective: To study the complement activation and apoptosis regular genes changes in the tissues of the perihematoma of intracerebral hemorrhage (ICH) in rats. Methods: Intracerebral hemorrhage was induced in rats by injection of bacterial collagenase into the caudate nucleus. Histopathological changes were studied in 6 h,12 h, 24 h, 2 d, 3 d, 5 d, 7 d after the injection. The immunohistochemistry and TUNEL analysis were performed. The expression of complement factor C3, the TUNELpositive cells, the proapoptotic gene expression (Bax) and the antiapoptotic gene (Bclxl) were examined. Results: The expression of C3 increased to its maximum between 2448 h. The TUNELpositive cells and Bax protein expression increased gradually and reached the peak level between 4872 h. The Bclxl protein reached the peak level at 48 h. The correlation analysis showed that the quantity of C3 was positively related to that of the TUNELpositive cells, but the bax protein was not related to Bclxl protein. Conclusion: The expression of complement factor C3 may contributes to the nerve injury after cerebral hemorrhage and relate to the apotosis in the tissues surrounding the hametoma in rats.