ICES (Intraoperative Stereotactic Computed Tomography-Guided Endoscopic Surgery) for Brain Hemorrhage: A Multicenter Randomized Controlled Trial.
ICES (Intraoperative Stereotactic Computed Tomography-Guided Endoscopic Surgery) for Brain Hemorrhage: A Multicenter Randomized Controlled Trial.
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DOI：
10.1161/strokeaha.116.013837
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发表时间：
2016-11
期刊：
影响因子：
8.3
通讯作者：
ICES Investigators
中科院分区：
文献类型：
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作者：
Vespa P;Hanley D;Betz J;Hoffer A;Engh J;Carter R;Nakaji P;Ogilvy C;Jallo J;Selman W;Bistran-Hall A;Lane K;McBee N;Saver J;Thompson RE;Martin N;ICES Investigators
脑出血(ICH)是一种破坏性的疾病，没有经过证实的治疗方法来改善长期结果。关于外科手术的作用仍然存在相当大的争议。微创内窥镜手术治疗脑出血提供了改善神经预后的潜力。我们验证术中计算机断层图像引导的内窥镜手术是安全和有效的，可以快速清除大部分血肿的假设。对20例(外科14例，内科4例)在脑出血发病48小时内血容量为20毫升的患者进行了前瞻性随机对照研究。我们前瞻性地使用了Mistie试验(微创手术和r-tPA用于脑出血清除)中的同期医学对照队列(n=36)。我们分别在6个月和1年评估手术安全性和神经学结果。术中CT引导下的内窥镜手术在出血后29h内出血量即刻减少68±21.6%(四分位数范围59~84.5)。所有病例均顺利完成手术，平均手术时间1.9h(四分位数1.5~2.2h)。围手术期发生1例手术相关出血，但无一例患者因术中出血、感染或死亡而达到手术安全止血阈值。手术干预组180天和365天神经功能恢复良好(改良Rankin评分0~3分)的患者比例高于内科对照组(42.9%比23.7%；P=0.19)。早期计算机断层成像引导下的内窥镜手术是一种安全有效的手术方法，可促进神经功能恢复。
Intracerebral hemorrhage (ICH) is a devastating disease without a proven therapy to improve long-term outcome. Considerable controversy about the role of surgery remains. Minimally invasive endoscopic surgery for ICH offers the potential of improved neurological outcome. We tested the hypothesis that intraoperative computerized tomographic image–guided endoscopic surgery is safe and effectively removes the majority of the hematoma rapidly. A prospective randomized controlled study was performed on 20 subjects (14 surgical and 4 medical) with primary ICH of >20 mL volume within 48 hours of ICH onset. We prospectively used a contemporaneous medical control cohort (n=36) from the MISTIE trial (Minimally Invasive Surgery and r-tPA for ICH Evacuation). We evaluated surgical safety and neurological outcomes at 6 months and 1 year. The intraoperative computerized tomographic image–guided endoscopic surgery procedure resulted in immediate reduction of hemorrhagic volume by 68±21.6% (interquartile range 59–84.5) within 29 hours of hemorrhage onset. Surgery was successfully completed in all cases, with a mean operative time of 1.9 hours (interquartile range 1.5–2.2 hours). One surgically related bleed occurred peri-operatively, but no patient met surgical safety stopping threshold end points for intraoperative hemorrhage, infection, or death. The surgical intervention group had a greater percentage of patients with good neurological outcome (modified Rankin scale score 0–3) at 180 and 365 days as compared with medical control subjects (42.9% versus 23.7%; P=0.19). Early computerized tomographic image–guided endoscopic surgery is a safe and effective method to remove acute intracerebral hematomas, with a potential to enhance neurological recovery.