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13 December 2021 : Clinical Research  

Comparison of Outcomes Following Neuronavigation-Assisted Aspiration and Thrombolysis Using Single and Multiple Catheter Insertion for Moderate-Volume Supratentorial Spontaneous Intracerebral Hemorrhage: A Single-Center Retrospective Study of 102 Patients

In-Hyoung Lee ORCID logo1ABCDEF, Jong-Il Choi ORCID logo2ACDEG*

DOI: 10.12659/MSM.934935

Med Sci Monit 2021; 27:e934935

Abstract

BACKGROUND: This retrospective study from a single center aimed to investigate 102 patients with isolated moderate-volume (30-60 mL) supratentorial spontaneous intracerebral hemorrhage (sICH) treated with neuronavigation-assisted aspiration and thrombolysis to compare outcomes using single and multiple catheter insertion.

MATERIAL AND METHODS: We retrospectively enrolled 102 patients (58 single-catheter insertion recipients and 44 multi-catheter insertion recipients) diagnosed with isolated moderate-volume supratentorial sICH who underwent neuronavigation-assisted aspiration and thrombolysis surgery in a single center between March 2017 and December 2019. The impact of multi-catheter insertion on the radiologic and clinical outcomes and complications were compared with those of single-catheter insertion.

RESULTS: The baseline characteristics, clinical status, and outcomes of both groups were not significantly different, except for the number of inserted catheters and surgical time. The single-catheter group had a significantly shorter surgical time than the multi-catheter group (39.52±8.76 min vs 61.39±16.6 min; P<0.001). The surgery-related complication catheter tract hemorrhage (CTH) occurred significantly more frequently in the multi-catheter group than in the single-catheter group (8.6% vs 27.3%; P=0.019). In the regression analysis, international normalized ratio prolongation and multi-catheter insertion were independent risk factors for CTH.

CONCLUSIONS: Single-catheter insertion is not inferior to multi-catheter insertion for isolated moderate-volume (30-60 mL) supratentorial sICH in terms of radiologic and clinical outcomes and significantly shortened the surgical time and reduced the incidence of CTH.

Keywords: catheters, Cerebral Hemorrhage, Neuronavigation, Tissue Plasminogen Activator, Treatment Outcome

Comments

Figures

Figure 1. Flow diagram demonstrating the patient selection process in this studyICH – intracerebral hemorrhage; CT – computed tomography. The figure was generated using Microsoft Word 2010 (Microsoft, Redmond, WA, USA).Figure 2. (A, B) Illustration of catheter tract hemorrhage on axial computed tomography scan obtained after surgery.The figure was created by the author from the PACS database of our institution using FastStone capture 9.0 (FastStone Soft).Figure 3. Medtronic AxiEM™ stereotactic neuronavigation targeting screen with target point in multiple planesA virtual line of the largest diameter of the hematoma marked and perpendicular to it on the axial and sagittal planes was drawn (dotted line). After evenly dividing the longest axis, we set the target points around each middle point (black arrow). The planned trajectory can be viewed in 3 planes simultaneously, and the guidance view (bottom right corner) can be used to monitor the position of the stylet in relation to the planned trajectory. The figure was edited using Microsoft PowerPoint 2010 (Microsoft, Redmond, WA, USA) after screenshot from the StealthStation® S7 AxiEM™ navigation system in our institution.Figure 4. Postoperative strategies and thrombolysis algorithm for moderate-volume (30–60 mL) supratentorial spontaneous intracerebral hemorrhage (sICH) in our institutionICH – intracerebral hemorrhage; CT – computed tomography; tPA – tissue plasminogen activator. The figure was created using Microsoft PowerPoint 2010 (Microsoft, Redmond, WA, USA).Figure 5. Brain computed tomography (CT) scans of a successful case of hematoma removal using single-catheter insertion in neuronavigation-assisted stereotactic aspiration and thrombolysis surgery(A) Spontaneous intracerebral hemorrhage of 15 mL in the right basal ganglia with the spot sign on the initial CT angiography scan. (B) Marked volume enlargement on the follow-up CT scan (57 mL). (C) Remarkable decrease in the hematoma volume after single-catheter insertion on the postoperative CT scan. (D) Approximately 80% of the hematoma had been removed as a result of tissue plasminogen activator administration on the follow-up CT scan 2 days after surgery. The figure was created by the author from the PACS database of our institution using FastStone capture 9.0 (FastStone Soft).Figure 6. Hematoma volume (A) and chronological change in the hematoma clearance rate (B) at various time points in the single and multiple catheter groups(A) There were no significant differences between the single (light blue bar) and multiple catheter groups (deep blue bar) in hematoma volume (mL) through all chronologies. (B) There were no significant differences between the single (light blue line) and multiple catheter groups (deep blue line) in hematoma clearance rate (%) through all chronologies. T0 – the time at which preoperative computed tomography (CT) scan was carried out; T1 – the time at which immediate postoperative CT scan was taken; T2 – postoperative 2 days; EOT – endpoint of treatment (the time of catheter removal); CR – clearance rate; ns – no significant difference between the 2 values. The figure was created with GraphPad Prism 9.3.0 (GraphPad Software, Inc., San Diego, CA, USA).

Editorial

01 January 2022 : Editorial  

Editorial: Current Status of Oral Antiviral Drug Treatments for SARS-CoV-2 Infection in Non-Hospitalized Patients

Dinah V. Parums
Science Editor, Medical Science Monitor, International Scientific Information, Inc., Melville, NY, USA

DOI: 10.12659/MSM.935952

Med Sci Monit 2022; 28:e935952

SARS-CoV-2/COVID-19

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750