A Novel Localized Puncture Technique For Treating Hypertensive Intracerebral Hemorrhage

BackgroundPrimary spontaneous hypertensive intracerebral hemorrhage(HICH)is a common disease in neurosurgery,with a higher incidence in China than in European and American countries.With the extension of life expectancy,China has entered an aging society gradually,which means that the incidence rate of the disease will increase year by year in the near future.Coupled with China's large cardinal number of population,HICH has become a major burden on the national health finance HICH is an urgent and critical disease,which can only be treated in the local hospital nearby.It has been the most commonly admitted disease in the Department of Neurology in hospitals at all levels in various regions.In recent years,the advantages of craniotomy for hematoma removal are not obvious,and the view of minimally invasive surgery(MIS)to treat this disease has been widely accepted by neurosurgeons.In various minimally invasive surgeries,stereotactic removal of intracerebral hematoma is a routine procedure for treating hypertensive intracerebral hemorrhage,but the surgical procedure is complicated and difficult to master,which limits its adoptionObjective:According to the principle of spatial stereotactic,we designed a set of simple and fast positioning method,and developed a stereotactic head rest and a matching smartphone app.We further explored the accuracy of stereotactic head frame in the puncture of HICH and the clinical application effect of a novel localized puncture technique for the removal of spontaneous intracerebral hematomasMethodThe surgical technique based on computed tomography(CT)images was used in hematoma projection and surgical planning.The CT images were input into the Android smartphone application.A new surgical technique was used to locate the center of the intracerebral hematoma and get its coordinate values(x,y,z).Using the data from the smartphone app,we can draw the marks needed for the installation of stereotactic head frame on the scalp of patients,so that we can choose an optimal trajectory to avoid important functional areas and blood vessels for puncture of the hematoma for effective drainage.We verified this positioning method in an experimental model,and performed a retrospective analysis of 42 patients who were guided by a stereotactic head frame for removing the hematoma.We compared the feasibility,accuracy,duration,preoperative and postoperative results of the novel localized puncture technique for the removal of spontaneous intracerebral hematomas.ResultAccording to the different sites of intracranial hematomas in the model,we used new surgical techniques to simulate clinical puncture and drainage in the hematoma model,and verified the accuracy of the stereotactic positioning method.On the basis of verifying the accuracy of puncture,forty-two patients with spontaneous intracerebral hemorrhage were included in the study,including 33 cases of supratentorial hemorrhage,5 cases of cerebellum hemorrhage and 4 cases of brain stem hemorrhage.The surgical technique combined with the stereotactic head frame helped the tip of the drainage tube achieve the desired position.The median surgical time was 45(range 25-75)minutes.The actual head frame operating time was 10(range 5-15)minutes.Target alignment performed by the surgical technique was accurate to?10.0 mm in all 42 cases.No patient experienced postoperative re-bleeding.In 33 cases of supratentorial intracerebral hemorrhage,an average evacuation rate of 77.5%was achieved at postoperative 3.1±1.4 days,and 29(87.9%)cases had a residual hematoma of<15 ml.The mean(± SD)preoperative Glasgow Coma Scale(GCS)score was 7.5±2.7;1 week after hematoma evacuation the mean GCS score had improved to 10.7±3.0(p<0.01).Conclusion:The novel localized puncture technique helped to quickly and effortlessly localize hematomas and achieve satisfactory hematoma removal.Clinical application of the stereotactic head frame was feasible for intracerebral hemorrhage in various locations,which can improve the accuracy of hematoma puncture,simplify the surgical procedure and shorten the operation time.The novel localized puncture technique is suitable for the emergency of intracerebral hemorrhage and is worth popularizing in the primary hospital.