Definition Of Ct Wedge Sign And Its Influence On The Therapeutic Effect Of Stereotactic Minimally Invasive Surgery In Patients With Thalamic Hemorrhage

Objective:Medial small amount of thalamic hemorrhage(MSATH)(≤ 10 m L)crossed the midline with a "wedge-like" shape,and the sagittal hematoma blocked mesencephalic aqueduct,such patients are prone to obstructive hydrocephalus and have a poor prognosis,so the Wedge Sign is defined.By comparing the effects of conservative treatment and minimally invasive surgery for patients with Wedge Sign,it provides imaging reference indicators for clinicians to accurately judge the clinical prognosis of such patients and choose treatment methods.Methods:A retrospective analysis of MSATH patients hospitalized in the Department of Emergency Neurology,Affiliated Hospital of Guizhou Medical University,Department of Neurology,Wudang Hospital Affiliated to Guizhou Medical University,and Department of Neurology,Danzhai County People’s Hospital from January 1,2014 to December 31,2021 were included.After screening by criteria and exclusion criteria,a total of 118 patients were enrolled.According to the location of thalamic hemorrhage observed by CT,118 patients were divided into conservative treatment group(84 cases)and surgical treatment group(34 cases).All patients were treated according to the Chinese Guidelines for Diagnosis and Treatment of Intracerebral Hemorrhage(2019).Demographic baseline data,clinical data and imaging data were recorded,and the m RS score of the patients at 90 days of onset was followed up by telephone.Results:1.The Wedge Sign is defined as spontaneous thalamic hemorrhage,on the cross-section of the brain CT,the hematoma is in line with MSATH(hematoma volume ≤ 10 m L),and the distance between the edge of the hematoma over the midline on the coronal plane is greater than 5mm,and the shape is like wedge.And compression of the third ventricle,sagittal hematoma blocking mesencephalic aqueduct.2.The influence of the Wedge Sign on the prognosis of patients: Multivariate binary logistic regression analysis found that the Wedge Sign,admission National Institute of Health Stroke Scale(NIHSS),admission Glasgow coma score(Glasgow Coma Score,GCS)are independent risk factors affecting the prognosis of neurological function in MSATH conservative treatment group(P < 0.05).For patients with Wedge Sign,the prognosis of patients with stereotaxic minimally invasive surgery at the end of 90-day outcome is better than that of patients with conservative treatment(P<0.05).3.The effect of Wedge Sign on the treatment effect of stereotactic minimally invasive surgery: Minimally invasive surgery can improve the clinical prognosis of patients with wedge sign(P<0.05).There was no significant difference in the prognosis of patients in the Wedge Sign group compared with the non-Wedge Sign group(P<0.05).Conclusions:1.The Wedge Sign observed on CT plain scan is an independent risk factor for poor prognosis of MSATH patients in conservative treatment group.2.The prognosis of patients with Wedge Sign is poor.Stereotactic minimally invasive surgery can improve the prognosis of patients with Wedge Sign.The Wedge Sign had no significant effect on the treatment effect of stereotactic minimally invasive surgery.