| Objective:To investigate the clinical availability and efficiency value of endoscopic evacuation in hypertensive intracerebral hemorrhage (HICH) via comparing with traditional craniotomy. To explore the accuracy and reliability of the Tada formula for measurement of intracerebral hematoma volume by comparing with results of software 3D-Slicer.Methods:This study contains 2 parts.In the first section, we summarize 151 consecutive patients who were operated on because of supratentorial hypertensive intracerebral hemorrhage between June 2010 and June 2014 in the department of neurosurgery in our hospital. Patients were separated into endoscopy group (82 cases) and craniotomy group (69 cases) depending on the surgical method they received. The evacuation rate was calculated with hematoma volume measured by 3D-Slicer. Comparison of operation time, intraoperative blood loss, GCS scores 1 week after surgery, hospitalization time and mRS scores at 6 months were also made between these 2 groups.In the second part, computed tomography (CT) scan data of 192 patients with intracerebral hemorrhage were collected. Hematoma volumes were calculated with 3D-Slicer and estimated by the Tada formula. Depending on the volume measured by 3D-Slicer, patients were divided into 3 groups. Group 1 included 57 patients with volume smaller than 30mL, group 2 included 71 patients with volume of 30-60mL, and group 3 contained 64 patients with volume larger than 60mL. Hematoma shape was divided into regular (62 cases), irregular (111 cases) and multilobular (19 cases). Results of the Tada formula and 3D-Slicer were compared on the basis of hematoma size and hematoma shape.ResultsIn the first section, there were no statistically significant difference of the preoperative data between endoscopy group and craniotomy group (p>0.05). The hematoma clearance rate was 90.5%±6.5% in endoscopy group and 82.3%±8.6% in craniotomy group, there was statistical significance (P<0.01). The time of operation was (1.6±0.7) h in endoscopy group and (5.2±1.8) h in craniotomy group (P<0.01). The intraoperative blood loss was (91.4±93.1) mL in endoscopy group and (605.6±602.3) mL in craniotomy group (P<0.01). The 1-week postoperative GCS scores was 11.5±2.9 in endoscopy group and 8.3±3.8 in craniotomy group (P<0.01). The hospital stay was (11.6±6.9) d in endoscopy group and (13.2±7.9) d in craniotomy group (P<0.05). The mean mRS scores at 6 months after surgery was 3.2±1.5 in endoscopy group and 4.1±1.9 in craniotomy group (P<0.05).In the second part, the hematoma volume was (50.3±31.9) mL by 3D-Slicer and (58.4±37.8) mL by the Tada formula (P<0.01). The Tada formula produced a mean overestimation of 8.1 mL and the mean percent deviation was 16.4%±9.2%. When grouped by hematoma size, the mean estimation errors were:3.2 mL (17.7%),5.7 mL (13.7%), and 15.0 mL (17.5%) in groups 1,2, and 3. When grouped by hematoma shape, the estimation errors were 3.4 mL (9.8%),7.0 mL (18.3%), and 29.2 mL (39.1%) in regular, irregular, and multilobular hematomas.Conclusion:Compared with traditional craniotomy, endoscopic evacuation is more effective, less invasive and may improve the prognosis of intracerebral hemorrhage. With rapid development of endoscope technology, endoscopic evacuation will get more clinical use. There is significant estimation error using the Tada formula to calculate hematoma volume. Compared with hematoma size, estimation error is more significantly associated with hematoma shape.3D-Slicer is a precise and convenient technique for measurement of intracerebral hematoma volume. |
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