Hematoma Evacuation via Image-Guided Para-Corticospinal Tract Approach in Patients with Spontaneous Intracerebral Hemorrhage

作者：Chao Zhang, Hongfei Ge, Shuixian Zhang, Dan Liu, Zhouyang Jiang, Chuan Lan, Lan Li, Hua Feng, Rong Hu · 发表于：Neurology and Therapy · 年份：2021 · DOI：10.1007/s40120-021-00279-8 · 被引用次数：152 · 研究领域：Intracerebral and Subarachnoid Hemorrhage Research、Traumatic Brain Injury and Neurovascular Disturbances、Cerebrospinal fluid and hydrocephalus

INTRODUCTION: Corticospinal tract injury caused by direct hematoma compression and secondary damage induced from blood toxic substances might influence the outcomes in patients with intracerebral hemorrhage (ICH). This study aimed to evaluate the safety and efficacy of hematoma evacuation via image-guided para-corticospinal tract approach based on the protection of compressed or residual corticospinal tract. METHODS: Seventy-five patients with ICH who underwent the image-guided para-corticospinal tract approach were retrospectively collected into the surgery group. Diffusion tensor imaging or computed tomography angiography was performed to identify the relationship between important white matter tracts and hematoma. The neuronavigation system for the preoperative imaging data loaded was used to identify the location of the burr hole, insertion trajectory, and depth of insertion. Cortical entry points and insertion trajectories were kept parallel to the corticospinal tract route into the hematoma based on the protection of compressed or residual corticospinal tract. Hematoma was removed under the image-guided para-corticospinal tract approach. Seventy-five age-, sex-, hematoma site-, and volume-matched patients with ICH who underwent conservative treatment were selected as controls. Demographical, clinical, radiological, and treatment-related data were retrospectively analyzed. Functional outcome was evaluated by modified Rankin scale on day 90. RESULTS: A total of 150 patien...