Abstract
Background and PurposeMinimally invasive surgery (MIS) is performed to treat patients with intracerebral hemorrhage (ICH) with favorable results. However, postoperative rehemorrhage is a significant risk. The present study retrospectively analyzed the association of irregular-shaped hematoma with postoperative rehemorrhage following stereotactic MIS (sMIS).MethodsWe enrolled 548 patients with spontaneous ICH who underwent sMIS. Based on the hematoma shape, the patients were assigned to the regular-shaped hematoma group (RSH group; 300 patients) or irregular-shaped hematoma group (ISH group; 248 patients). Logistic regression analysis was performed to identify the predictors of postoperative rehemorrhage after sMIS for ICH evacuation. The functional outcome was assessed using the modified ranking scale (mRS) score at discharge. A receiver operating characteristic (ROC) curve was used to confirm the results.ResultsAmong 548 patients with ICH who underwent sMIS, 116 developed postoperative rehemorrhage. Postoperative rehemorrhage occurred in 30.65% of patients with ISH and 13.30% with RSH (P < 0.01), with a significant difference between the ISH and RSH groups. Among 116 patients with postoperative rehemorrhage, 76 (65.52%) showed ISH on CT scan. In 432 patients without postoperative rehemorrhage, only 39.81% displayed ISH. The logistic regression analysis demonstrated that ISH could independently predict postoperative rehemorrhage. The sensitivity, specificity, positive predictive value, and negative predicative value were 0.655, 0.398, 0.655, and 0.602, respectively. The ROC analysis confirmed the value of ISH in predicting postoperative rehemorrhage with an area under the curve of 0.629.ConclusionsIrregular-shaped hematoma was an independent predictor of postoperative rehemorrhage after sMIS.
Highlights
Spontaneous intracerebral hemorrhage is associated with high mortality and disability worldwide
Postoperative rehemorrhage occurred in 30.65% of patients with irregular-shaped hematoma (ISH) and 13.30% with regular– shaped hematoma (RSH) (P < 0.01), with a significant difference between the ISH and RSH groups
The receiver operating characteristic (ROC) analysis confirmed the value of ISH in predicting postoperative rehemorrhage with an area under the curve of 0.629
Summary
Spontaneous intracerebral hemorrhage (sICH) is associated with high mortality and disability worldwide. Newer surgical techniques for ICH management, called minimally invasive surgery (MIS), have been evaluated in several large clinical trials [7]. In a recently published study, MIS did not increase the proportion of patients who achieved a good outcome 365 days after ICH, reduction of the hematoma size to 15 ml or less was associated with improved modified ranking scale (mRS) scores at 365 days in stabilized patients [11]. Other studies found that the rate of postoperative rehemorrhage or rebleeding was almost 26.19% in patients with ICH who underwent MIS and 40% in patients with ICH during the early stage after open surgery [13]. Invasive surgery (MIS) is performed to treat patients with intracerebral hemorrhage (ICH) with favorable results. The present study retrospectively analyzed the association of irregular-shaped hematoma with postoperative rehemorrhage following stereotactic MIS (sMIS)
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