娄金峰,杨璨宇,王在斌,姜帆,陶胜忠,牛光明

• 1:郑州大学第二附属医院
• 2:郑州大学第一临床医学院

摘要(Abstract)：

目的 探讨多模态影像融合与神经导航联合引导下无框架立体定向穿刺抽吸引流治疗脑干出血的效果。方法 对2018-10—2023-10郑州大学第二附属医院神经外科运用多模态影像融合和神经导航引导的无框架立体定向精准穿刺抽吸引流技术治疗的35例脑干出血患者的临床数据进行回顾性研究。术后24 h复查头颅CT以判断脑干引流后的残余血肿量，同时依据残余血肿量决定是否注射尿激酶引流。手术前后进行GCS量表评估，术后30 d对所有患者进行随访，了解其存活状态，并对存活者进行mRS评估。结果 35例患者手术均一次性穿刺成功，术中无死亡。术后24 h头颅CT复查显示，35例患者的颅内残余血肿量（3.8±1.2）mL，血肿清除率（61.3±26.4）%。术前GCS评分（6.9±3.1）分，术后（9.6±3.2）分，手术前后GCS评分存在统计学差异（P<0.05）。术后30 d随访，35例患者中30例存活，5例死亡，病死率14.3%，存活患者mRS评分（3.8±1.0）分。结论 多模态影像融合与神经导航联合引导下无框架立体定向穿刺抽吸引流治疗脑干出血的疗效较好，能有效清除脑干血肿，解除血肿对脑干的压迫，避免继发性损伤，从而降低病死率及致残率，改善患者预后。

关键词(KeyWords)： 脑干出血;继发性脑损伤;多模态;无框架立体定向;神经导航;影像融合;血肿抽吸引流术

Abstract:

Keywords:

基金项目(Foundation): 河南省科技攻关项目(编号:232102310279)

作者(Author): 娄金峰,杨璨宇,王在斌,姜帆,陶胜忠,牛光明

参考文献(References)：

• [1] WANG S S,YANG Y,VELZ J,et al. Management of brainstem haemorrhages[J]. Swiss Med Wkly,2019,149:w20062. DOI:10.4414/smw.2019.20062.
• [2] MENG X, WANG Q,PEI X,et al. Prognosis and Influencing Factors of Early Microsurgery for Severe Hypertensive Brainstem Hemorrhage[J]. Dis Markers, 2022, 2022:5062591. DOI:10.1155/2022/5062591.
• [3] ZHENG W J,SHI S W,GONG J. The truths behind the statistics of surgical treatment for hypertensive brainstem hemorrhage in China:a review[J]. Neurosurg Rev,2022,45(2):1195-1204.DOI:10.1007/s10143-021-01683-2.
• [4] LIU B, ZHENG T,MAO Y,et al. Endoscopic Endonasal Transclival Approach to Spontaneous Hypertensive Brainstem Hemorrhage[J]. JCraniofacSurg,2020,31(5):e503-e506.DOI:10.1097/SCS.0000000000006599.
• [5] LIU G,SUN J,ZUO S,et al. The signs of computer tomography combined with artificial intelligence can indicate the correlation between status of consciousness and primary brainstem hemorrhage of patients[J]. Front Neurol,2023,14:1116382.DOI:10.3389/fneur.2023.1116382.
• [6] CHEN P,YAO H,TANG X,et al. Management of Primary Brainstem Hemorrhage:A Review of Outcome Prediction,Surgical Treatment,and Animal Model[J]. Dis Markers,2022,2022:4293590. DOI:10.1155/2022/4293590.
• [7] YANG S,LIU Y,WANG S,et al. Stereotactic Puncture Surgery for the Treatment of Moderate Volume of Thalamus-Internal Capsule Area Hemorrhage:An Analysis of Real-World Data[J].World Neurosurg,2024,186:e213-e226. DOI:10.1016/j.wneu.2024.03.107.
• [8] DU L,WANG J W,LI C H,et al. Effects of stereotactic aspiration on brainstem hemorrhage in a case series[J]. Front Surg,2022,9:945905. DOI:10.3389/fsurg.2022.945905.
• [9] LI L,WANG A J,ZHANG H B,et al. Development and initial experience of a novel classification system for patients with brain stem haemorrhage[J]. Folia Neuropathol, 2023, 61(3):301-308. DOI:10.5114/fn.2023.131122.
• [10] SONG Q, LIANG Y, ZHANG Y, et al. Effect of Mild Therapeutic Hypothermia Combined with Stereotactic Aspiration on Patients with Severe Cerebral Hemorrhage[J]. Mol Biotechnol,2023 Oct 16. DOI:10.1007/s12033-023-00882-0.
• [11] MAO Y,SHEN Z,ZHU H,et al. Observation on therapeutic effect of stereotactic soft channel puncture and drainage on hypertensive cerebral hemorrhage[J]. Ann Palliat Med,2020,9(2):339-345. DOI:10.21037/apm.2020.03.
• [12] GU C,LV J,YUAN D. The clinical effect of minimally invasive stereotactic puncture intracranial hematoma removal in the treatment of patients with cerebral hemorrhage:a meta-analysis[J]. Cir Cir,2023,91(6):762-772. DOI:10.24875/CIRU.22000453.
• [13] WU J,WU X,ZHANG Y,et al. Surgical Treatment for Severe Primary Midbrain and Upper Pons Hemorrhages Using a Subtemporal Tentorial Approach[J]. J Neurol Surg B Skull Base,2022,84(3):281-287. DOI:10.1055/s-0042-1745737.
• [14] DEMERATH T,STANICKI A,ROELZ R,et al. Accuracy of augmented reality-guided drainage versus stereotactic and conventional puncture in an intracerebral hemorrhage phantom model[J]. J Neurointerv Surg,2023,15(7):708-711. DOI:10.1136/neurintsurg-2022-018678.
• [15] YU Z,ZHANG X,XU Q,et al. Effect of hematoma volume on the 30-day mortality rate of patients with primary hypertensive brainstem hemorrhage:a retrospective cohort study[J]. Front Surg,2023,10:1136296. DOI:10.3389/fsurg.2023.1136296.
• [16] CHEN L H,LI F J,ZHANG H T,et al. The microsurgical treatment for primary hypertensive brainstem hemorrhage:Experience with 52 patients[J]. Asian J Surg,2021,44(1):123-130. DOI:10.1016/j.asjsur.2020.04.016.
• [17] YANG S,LIU Y,WANG S,et al. Stereotactic puncture surgery combined with early hyperbaric oxygen therapy may be better for long-term functional recovery in patients with moderate amounts of thalamic-inner capsule region haemorrhage[J]. Clin Neurol Neurosurg,2024,241:108287. DOI:10.1016/j.clineuro.2024.108287.
• [18] BEUCLER N, CUNGI P J, DAGAIN A. Duret Brainstem Hemorrhage After Transtentorial Descending Brain Herniation:A Systematic Review and Meta-Analysis[J]. World Neurosurg,2023,173:251.e4-262.e4. DOI:10.1016/j.wneu.2023.02.110.
• [19] ALMOHAMMEDI R M,ALMUTAIRI H,ALHOUSSIEN R O,et al. Brainstem hemorrhage is uncommon and is associated with high morbidity, mortality, and prolonged hospitalization[J].Neurosciences(Riyadh),2020,25(2):91-96. DOI:10.17712/nsj.2020.2.20190102.
• [20] WIJDICKS E F M. The Origin of Intracranial Pressure Causing Brainstem Hemorrhages[J]. Neurocrit Care,2020,32(1):323-326. DOI:10.1007/s12028-019-00688-6.
• [21]?KTEM E?，KUMRAL E,BAYAM F E,et al. Prognostic Factors For Functional Outcome in Patients with Mesencephalic Hemorrhage[J]. Noro Psikiyatr Ars,2023,60(1):9-16. DOI:10.29399/npa.28244.
• [22] TANG Z,HUANG W,CHEN Q,et al. Curative effect analysis of robot-assisted drainage surgery in treatment of spontaneous hypertensive brainstem hemorrhage[J]. Front Neurol,2024,15:1352949. DOI:10.3389/fneur.2024.1352949.
• [23] GITSHC,ANDERSONM,STALLARDS,etal.Medulloblastoma therapy generates risk of a poorly-prognostic H3 wild-type subgroup of diffuse intrinsic pontine glioma:a report from the International DIPG Registry[J]. Acta Neuropathol Commun,2018,6(1):67. DOI:10.1186/s40478-018-0570-9.
• [24]中华医学会神经外科学分会脑血管病学组，中国医师协会神经外科医师分会脑血管外科学组.原发性脑干出血诊治中国神经外科专家共识[J].中华医学杂志，2022,102(15):1068-1075.
• [25] LANGE K S,TAIEB G,LEPRETRE P,et al. A rare cause of midbrain haemorrhage[J]. Eur J Neurol, 2021, 28(3):e22-e24. DOI:10.1111/ene.14688.
• [26] LIU Y Q,SONG Z H,LIU C Y,et al. A novel surgical technique for spontaneous intracerebral hematoma evacuation[J]. Neurosurg Rev,2021,44(2):925-934. DOI:0.1007/s10143-020-01252-z.
• [27] HAO G,XU Z,ZHU J. Surgical treatment of spontaneous brainstem hemorrhage:A case repor[tJ]. Medicine(Baltimore),2019,98(51):e18430. DOI:10.1097/MD.0000000000018430.
• [28]夏磊，尚进，朱晓峰，等. 3D打印辅助微创精准穿刺治疗脑干出血的临床研究[J].中国实用神经疾病杂志，2022,25(9):1063-1067. DOI:10.12083/SYSJ220761.
• [29] WANG X J,ZHANGL,YINYH,etal.CaseReport:Endoscopic trans-cerebellar medullary fissure approach for the management of brainstem hemorrhage[J]. Front Neurol,2023,14:1173905.DOI:10.3389/fneur.2023.1173905.
• [30] KRISHNAN MUTHAIAH V P,CORNEJO I N,HARIHARAN S,et al. Disabling tinnitus and third nerve palsy following pontine hemorrhage:Application of ICF framework[J]. Clin Case Rep,2024,12(2):e8405. DOI:10.1002/ccr3.8405.
• [31] BOUCHLARHEM A,HADDAR L,NASRI S,et al. Brainstem stroke:A fatal thromboembolic event after new onset atrial fibrillation during covid-19 infection:A case report and literature review[J]. Radiol Case Rep,2021,16(11):3244-3249. DOI:10.1016/j.radcr.2021.07.090.
• [32] CHEND,TANG Y,NIE H,etal.PrimaryBrainstemHemorrhage:A Review of Prognostic Factors and Surgical Management[J].Front Neurol,2021,12:727962. DOI:10.3389/fneur.2021.727962.
• [33] GENG Y,WANG T,LIU Y,et al. How to predict the outcome of primary brainstem hemorrhage:Six-year results of a single-center retrospective analysis[J]. Medicine(Baltimore),2023,102(37):e35131. DOI:10.1097/MD.0000000000035131.
• [34] DING W L,XIANG Y S,LIAO J C,et al. Early tracheostomy is associated with better prognosis in patients with brainstem hemorrhage[J]. J Integr Neurosci,2020,19(3):437-442.DOI:10.31083/j.jin.2020.03.25.