Hematoma Clearance Research Articles

Comparison of the clinical effect of craniotomy operation and keyhole minimally invasive operation in the treatment of cerebral hemorrhage

Objective To explore the effect of craniotomy operation and keyhole minimally invasive opera-tion in the treatment of patients with cerebral hemorrhage .Methods 90 patients with cerebral hemorrhage were ran-domly divided into control group and observation group .45 cases in the control group were given conventional cranioto-my to clear hematoma ,45 cases in the observation group received keyhole minimally invasive operation .The operation＆nbsp;time,blood transfusion amount , hematoma clearance rate , residual hematoma volume , GOS scale were recorded and compared between the two groups.Postoperative follow-up for one year,the rehospitalization rate,mortality,the Barthel index score,curative effect were compared .Results The operation time and blood transfusion amount of the observa-tion group were （92.5 ±18.1） min,（125.0 ±23.4） mL,which were significantly less than （125.6 ±20.3） min, （325.0 ±104.5）mL of the control group （P0.05）.The effective rate of the ob-servation group（91.1%） was obviously higher than that of the control group （62.2%）,the difference was statistically significant（P〈0.01）.The patients were followed up for one year postoperation ,the rehospitalization rate and mortali-ty of the observation group were 20.0% and 5.0%,which were significantly lower than those of the control group （42.1%,15.8%）（P〈0.05）.While the Barthel index score of the observation group was higher than that of the control group,the difference was significant （P〈0.05）.Conclusion Keyhole minimally invasive operation in the treatment of cerebral hemorrhage has good clinical curative effect ,with advantages of simple operation ,less trauma, good surgery prognosis ,which is worthy of further clinical promotion . Key words: Keyhole minimally invasive operation; Craniotomy operation; Cerebral hemorrhage

Abstract W MP95: CCR2+ Monocytes Contribute to Hematoma Clearance After Experimental Intracerebral Hemorrhage

Background: Inflammation is a key contributor to injury and recovery after intracerebral hemorrhage (ICH). CCR2+ monocytes were recently identified as mediators of early injury in a rodent ICH model, but their potential roles in ICH recovery have not been addressed. The purpose of this study was to determine how CCR2+ monocytes influence repair and recovery after ICH Methods: Ccr2-/- bone marrow was transplanted into wild type congenic mice to create chimeras with normal microglia, but few circulating monocytes. Control mice received wild type bone marrow. Mice were subjected to the blood injection ICH model, whereby 20 μl of blood were injected into the striatum. The resulting motor weakness was quantified using the cylinder and beam balance tests. Residual hemoglobin was quantified in brains at day 7 using Drabkin’s reagent. In wild type mice, 1-μm fluorescent beads were injected with the blood as a phagocytosis substrate. An imaging flow cytometer was used to visualize phagocytic cells. Results: Mice with Ccr2-/- bone marrow have less severe motor deficits up to day 3, but both genotypes were equally recovered at day 7. Despite normal behavior, mice with Ccr2-/- bone marrow had significantly more residual hemoglobin in their brains (8.92 ± 1.03 vs. 3.96 ± 2.80 μl, p<0.05; Fig.), suggesting a role for monocytes in ICH clearance. To determine if monocytes have the capacity to phagocytose debris after ICH, we injected fluorescent beads with the ICH blood. CCR2+ monocytes engulfed more beads than resident microglia at day 1 (4.35 ± 2.23 vs. 0.23 ± 0.45 beads, p<0.0001; Fig.), suggesting a more active role in phagocytosis. Conclusions: Hematoma clearance has been attributed mainly to microglia, but these results indicate that CCR2+ monocytes are also involved. Interestingly, the lack of a motor deficit at day 7 indicates that the presence of a hematoma does not inhibit functional recovery in the absence of CCR2+ inflammatory monocytes.

Abstract W MP88: Reduced Platelet Activity is Associated With Intraventricular Hematoma Clearance

Background: Reduction of intraventricular hematoma (IVH) burden is a novel therapeutic target for patients with intraventricular extension of intracerebral hemorrhage, yet little is known about clinical factors that may mediate IVH clearance. We tested the hypothesis that coagulation and platelet function abnormalities were associated with IVH clearance. Methods: Patients with primary intracerebral hemorrhage were enrolled into a prospective registry between December 2006 and June 2013. We studied patients with IVH who underwent ventricular drainage and survived to discharge. Diagnostic and surveillance neuroimaging studies were analyzed for the presence of IVH and quantified by Graeb score. We used univariate analysis to select candidate variables (p<0.25) into a logistic regression model to identify clinical and radiographic factors independently associated with IVH clearance, defined as a decrease between highest to final Graeb score over up to 7 days. We assessed coagulation function by international normalized ratio (INR) and platelet function by aspirin reaction units (ARU), with decreasing ARU indicating aspirin-associated platelet dysfunction. Results: There were 289 subjects in the cohort, of which 53 met inclusion criteria for this analysis. Univariate analysis identified age, hematoma volume, hydrocephalus, development of ventriculitis, INR, ARU, and observation interval between peak Graeb score and follow up imaging as potentially associated with IVH clearance. Multivariate modeling confirmed that platelet function by ARU (OR 0.990 IQR 0.992-0.998, p=0.019) and the observation interval (OR 1.024 per hour IQR 1.004-1.025, p=0.021) were independently associated with observing IVH clearance. Conclusion: After correction for observation interval, aspirin-related platelet dysfunction is the clinical variable most strongly associated with IVH clearance in patients with intraventricular extension of intracerebral hemorrhage. These findings suggest an important interaction between platelet function and hematoma stability.

Vaccum drainage system application in the management of operation-related non-regional epidural hematoma

BackgroundEpidural intracranial hematoma is one of the most common complications of surgeries for intracranial tumors. The non-regional epidural hematoma is related to severe fluctuation of the intracranial pressure during the operation. The traditional management of hematoma evacuation through craniotomy is time-consuming and may aggravate intracranial pressure imbalance, which causes further complications. We designed a method using vaccum epidural drainage system, and tried to evaluate advantage and the disadvantage of this new technique.MethodsSeven patients of intracranial tumors were selected. All of the patients received tumor resection and intra-operative non-regional epidural hematoma was confirmed through intra-operative ultrasound or CT scan. The vaccum drainage system was applied. Another ten patients who received craniotomy for intra-operative non-regional epidural hematoma evacuation were selected as comparison. Regular tests, like serial CT scan, were performed afterward to evaluate the effectiveness and to help deciding when to remove the drainage system.ResultsThe vaccum drainage method was effective in epidual hemotoma clearance and prevented recurrent epidural hemorrhage. The drainage systems were removed within 4 days. All of the patients recovered well. No complications related to the drainage system were observed.ConclusionsCompared to the traditional craniotomy, the new method of epidural hemoatoma management using vaccum epidural drainage system proved to be as effective in hematoma clearance, and was less-invasive and easier to perform, with less complication, shorter hospitalization, less economic burden, and better prognosis.

A clinical comparison of endoscopic surgery versus craniotomy in hypertensive basal ganglia intracerebral hemorrhage

Objective To compare the clinical effects and characteristics between hypertensive intracerebral hemorrhage (HICH) and haematoma clearance by craniotomy for basal ganglia.Methods Clinical data of 50 patients with HICH in basal ganglia were collected,including operation duration,amount of intraoperative bleeding,cleared amount of haematoma,postoperative intracranial infection,and GOS at the sixth month after operation.The patients were divided into endoscopic group and craniotomy group.Clinical effects were analyzed by using GOS at the sixth month as a prognosis index.Results Preoperatively,the two groups showed no significant difference in any type of clinical materials(all P ＞ 0.05).Operation durations were (1.5 ± 0.8) h and (3.5 ± 1.1) h (P ＜ 0.05),respectively; amounts of intraoperative bleeding were (40.0 ± 19.7) rnl and (40.6 ± 13.2) ml (P ＜ 0.05),respectively; clearance rates of haematoma were (92.6 ± 9.4) ％ and (73.1 ± 21.1) ％ (P ＜ 0.05),respectively; cases of postoperative intracranial infections were 0 and 3 (P ＜ 0.05),respectively,for the endoscopy group and the craniotomy group.GOS prognosis at 6 months showed 7 cases of good recovery,12 cases of slight disability,2 cases of severe disability,1 case of vegetative state,and 1 death in the endoscopy group;6 cases of good recovery,9 cases of slight disability,6 cases of severe disability,3 case of vegetative state,and 1 death in the craniotomy group.Prognosis was better in the endoscopy group than in the craniotomy group(P ＜ 0.05).Conclusion Endoscopic surgery is an efficient and minimally invasive and operating technique for the treatment of hypertensive basal ganglia intracerebral hemorrhage. Key words: Intracranial hemorrhage, hypertensive; Neurosurgical procedures ; Minimally invasive; Removal

Thrombolytic Evacuation of Intracerebral and Intraventricular Hemorrhage

Intracranial hemorrhage (ICH) accounts for 10-15 % of all strokes, however it causes 30-50 % of stroke related mortality, disability and cost. The prevalence increases with age with only two cases/100,000/year for age less than 40 years to almost 350 cases/100,000/year for age more than 80 years. Several trials of open surgical evacuation of ICH have failed to show clear benefit over medical management. However, some small trials of minimal invasive hematoma evacuation in combination with thrombolytics have shown encouraging results. Based on these findings larger clinical trials are being undertaken to optimize and define therapeutic benefit of minimally invasive surgery in combination with thrombolytic clearance of hematoma. In this article we will review some of the background of minimally invasive surgery and the use of thrombolytics in the setting of ICH and intraventricular hemorrhage (IVH) and will highlight the early findings of MISTIE and CLEAR trials for these two entities respectively.

The influence of the pure liquefaction diversion and rinse liquefaction drainage on the re-bleeding after the operation of intracranial haematoma minimally invasive surgery

Objective To explore the different effects on the bleeding after the surgery of minimally invasive intracranial haematoma with drainage method.Methods The cases with minimally haematoma invasive operation were divided into A and B group.Group A simply used the liquefaction agent for blood clots( urokinase mixed with hyaluronidase),without washing step,and Group B used saline water to wash repeatedly and then use liquefaction agent to divert.Results The hematoma clearance rate of A group equal to that of B Group,while the rate of re-bleeding was ( 3.8 ％ ) obviously lower than than of B Group ( 22.7％ ) ( x2 =4.594,P ＜ 0.05 ).Condusion For many cases who have experienced the minimally invasive intracranial operation,the simple use of liquefaction agent can divert haematoma,and the risky rate of re-bleeding was obviously lowered. Key words: Intracranial haematoma; Drainage

Clinical application of large craniotomy decompression in treatment of severe craniocerebral injury combined with massive cerebral infarction

Objective To retrospectively review the efficacy of large craniotomy with subtemporal decompression in the treatment of severe craniocerebral injury combined with cerebral infarction.Methods Forty-eight patients suffering from severe craniocerebral injury combined with cerebral infarction were randomized into the treatment group (managed by large craniotomy decompression) and the control group (managed by clearance of hematoma by routine craniotomy ).A retrospective analysis was carried out to compare the cerebral infarction size between the two groups before operation and at day 1 and 1 week after operation and the outcomes of the two corresponding groups three months post-operatively.Results The infarction size of the treatment group was insignificant in comparison with that of the control group pre-operatively and at day 1 post-operatively,but was significantly smaller than that of the control group one week post-operatively (P ＜ 0.05 ).The mortality and moderate disability/good rate of the treatment and control groups presented significant differences three months post-operatively (21％,42％ vs 33％,25％ respectively,P ＜ 0.05 ).Conclusion Large craniotomy decompression is effective in treating severe craniocerebral injury combined with cerebral infarction and plays an important role in reducing disability and mortality. Key words: Decompression, surgical; Brain infarction; Craniocerebral trauma

Cubic oriented stereotactic hematoma aspiration combined with urokinase and dexamethasone in treatment for hypertensive thalamic hemorrhage (report of 65 cases)

Objective To investigate the clinical results and significance of aspirating hypertensive thalamic hemorrhage by cubic oriented stereotactic hematoma aspiration combined with urokinase and dexamethasone.Methods The clinical experience of hypertensive thalamic hemorrhage of 65 cases treated with cubic oriented stereotactic hematoma aspiration combined with urokinase and dexamethasone was retrospectively analyzed.Cranial CT scan was used to survey the volumes of hematomas and encephaledema.Results Hematoma volume was evacuated more than 95％ during 24 hours post-operation in 19(29.2％),more than 95％ during48 hours post-operation in 42(64.6％); one month after the operation,GOS score achieved 4～5 in 48 patients (73.8％),and the mortality was 0.15％.Conclusion Cubic oriented stereotactic hematoma aspiration combined with urokinase and dexamethasone can be applied at the bedside with accurate location,high efficacy and safety,easy operation,speeding the clearance of hematoma,and decreasing encephaledema. Key words: Hypertension; Intracerebral hemorrhage; Stereotaxic techniques; Urokinase; Dexamethasone

Clinical analysis of micro-neurosurgical operation for hypertensive intracerebral hemorrhage in primary hospital

Objective To investigate value of minimally invasive surgical approach in patients with hypertensive intracerebral hemorrhage in primary hospital.Methods According to the operation procedure,93 cases with basal ganglia hemorrhage were divided into three groups:1.minimally invasive surgery group A (n =37 ),2.ventricular puncture and drainage,lumbar cistern drainage group B(n=10),3.usual operation group C( n =46).Estimated operation effect with computed tomography in 24 hours after operation.Case fatality rate and complication incidence were analyzed after three months of operation according to the Glasgow Outcome Scale (GOS).Results Minimally invasive surgery group A had the highest hematoma clearance rate (82.7 ± 8.1 ) ％,group B (78.6±6.5 ％ ),group C (50 ±10％ ).The incidence rate of rebleeding was 8.1％ in group A( n =3 ),10％ in group B ( n =1 ),34.8％ in group C (n =16).The grade Ⅳ of the GOS and the grade Ⅲ of the GOS was respectively 93.8％ and 6.5％,case fatality rate was zero.Conclusion The minimally invasive surgical operation not only lead to less tissue damage and decrease rebleeding,but also improve neurological functional recovery. Key words: Brain hemorrhage ; Microsurgery

Skull positioning device in the treatment of epidural hematoma

Objective To study the clinical value of the skull positioning device in the treatment of epidural hematoma. Method Patients, whose conditions were relatively stable, and the supratentorial epidural hematoma were between 20 ～ 65 ml, were put the locator on before head CT scan. According to the results, we drew projections of the hematoma on their heads surface, and designed smaller incisions and bone flaps before operations. During operations, we removed the hematoma clearly, and stopped bleeding effectively, replace bone flap and fix it with crania fixation system. Result The error between projection positions and actual positions are less than 3mm. The operative incisions and the bone flaps are much smaller than traditional surgery. The hematoma clearance rate is over 90%.Conclusion The accurate positioning makes each step of surgery more reasonable. It helps us to get better therapeutic effeet with less lesion. It should be popularized and applied in clinic. Key words: Skull positioning device; Epidural hematoma; Projection on head surface

Early hematoma piercing attract combining with hematoma clearance to bone valves decompression technique to treat high blood pressure brain hemorrhage

Objective To explore hematoma piercing attract joint hematoma clearance to bone valves decompression technique in hematoma volume,skull,pressure high blood pressure brain hemorrhage treatment,and to further explore hypertension brain hemorrhage of reasonable surgery. Methods Hematoma in relatively large quantities of high intracranial pressure in hypertensive cerebral hemorrhage patients were randomly divided into experimental group and control group,and patients in the experimental group were implemented early hematoma puncture to attract a joint hematoma decompressive craniectomy treatment,and the control group were implemented the traditional hematoma de-compressive craniectomy treatment. The prognosis of the two groups were compared. Results The two groups were followed up for 6 months,and evaluated by ADL grade,between the two groups was statistically significant difference in ADL classification( P<0.01). Conclusion In the hematoma volume larger, high intracranial pressure in hypertensive cerebral hemorrhage in the surgical treatment of patients,the early line to attract a joint hematoma puncture decompressive craniectomy was a reasonable and feasible surgical method which can improve these patients prognosis. Key words: Intracranial hemorrhage, hypertensive ; Paracenteais; Craniotomy

An effective treatment for cerebral hemorrhage: minimally invasive craniopuncture combined with urokinase infusion therapy

Objectives: To evaluate and compare the curative effect between the minimally invasive craniopuncture combined with urokinase infusion therapy and the clearance of hematoma by craniotomy with small bone flap in treating patients with 30–80 ml hemorrhage in the basal ganglion part of the brain.Methods: A multicenter, randomized control clinical trial was undertaken; it comprised of 22 hospitals in China. Three hundred and four patients with hemorrhage in the basal ganglion were randomly assigned to receive the craniopuncture combined with urokinase infusion therapy (n=159) or clearance of hematoma by craniotomy with small bone flap treatment (n=145). The main indexes of evaluation were the neurological impairment degree at day 14 after treatment, activities of daily living at day 90 and the case fatality by 90 days.Results: The main results were as follows: (1) there was a significant difference in favorable outcomes (Barthel index ≥95) between the two groups (χ2=3·95, p<0·05), which showed a better prognosis in the craniopuncture group, although there was no significant difference in improving the neurological functions and activities of daily living at day 90; (2) there was a remarkable decrease in case fatality by 90 days in the cranipuncture group, with statistically significant difference between the two groups (χ2=5·35, p=0·02); (3) the re-bleeding rate in cranipuncture group was 8·8%, significantly (χ2=9·51, p=0·002) lower than 21·4% in the craniotomy group.Conclusion: The craniopuncture combined with urokinase infusion therapy could reduce the rate of re-bleeding after surgery and the case fatality by 90 days. It also could improve the activities of daily living (Barthel index ≥95) at day 90. Thus, this therapy was a safe and practical technique in treating cerebral hemorrhage (30–80 ml), especially suitable for hospitals in rural areas or developing countries.

Diagnoses and treatment of severe traumatic brain injury in 4 462 cases: a retrospective study

Objective To analyze and summarize the experiences in diagnosis and treatment of patients with severe traumatic brain injury (sTBI) so as to increase the cure rate and survival rate. Methods A retrospective study was made on the diagnoses and treatment of 4 462 cases of sTBI inclu-ding 3 298 males (73.9%) and 1 164 females (26.1%). The most frequent cause for injury was traffic accident, accounting for 35.5% (1 583/4 462). Closed bead injury ocurred in 3 654 cases (81.9%) and open head injury in 808 (18.1%). The most commen clinical manifestations included unconscious-ness, changes of pupils and life signs. Of all, 1 158 cases (26.0%) were found with combined injury and 1 356 (30.4%) with complications. Treatment measures included first aid, surgery or conventional treatment. Emphasis was put on the treatment of secondary insults. Results Surgery was performed in 3 023 cases (67.7%) including craniotomy for hematoma clearance in 856 cases and hematoma clearance plus decompression in 2 167, with mortality rate of 17.9%. Conventional treatment was carried out in 1 439 cases (32.3%), with mortality rate of 23.7%. There were 2 462 eases (55.2%) with fair recov-ery, 508 (11.4%) with mild disability, 339 (7.6%) with severe disability, 272 (6.1%) under vege-tative state and 881 (19.7%) deaths on discharge according to the Glasgow Outcome Scale. Conelu-sions Active diagnoses and treatment, strict medication rules and prevention and treatment of secondary insults may be key to higher eure rate as well as lower morbidity and mortality of sTBI. Key words: Brain iniurios, severe; Diagnosis; Treatment