原 著
内視鏡下脳内血腫除去術における血腫除去困難例の検討
キーワード:
intracerebral hematoma,
intraventricular hematoma,
neuroendoscope,
evacuation of hematoma,
antithrombotic drug
2020 年 48 巻 3 号 p. 205-209
詳細
2020 年 48 巻 3 号 p. 205-209
Background and Purpose: Endoscopic evacuations of intracerebral hematomas (ICHs) and intraventricular hematomas (IVHs) have become increasingly popular in recent years. However, evacuation of hematomas can occasionally be insufficient. The purpose of this study was to identify the factors making evacuation difficult.
Methods: Between 2010 and 2017, endoscopic evacuations of a total of 55 ICHs and IVHs were performed in 53 patients. Insufficient hematoma evacuation was defined as follows: an ICH evacuation rate of less than 50% and a Graeb score (GS) decreasing rate of less than 50%. Clinical variables were analyzed.
Results: The average evacuation rate was 71.6% for ICHs, and the GS decreasing rate was 60.4% for IVHs. Insufficient evacuations tended to be more for IVHs than for ICHs, but without a statistically significant difference (28.9% vs 5.0%, p = 0.127). There were no significant differences in factors, such as age, sex, Glasgow Coma Scale (GCS) score, GS, time to surgery, or modified Rankin scale (mRS) score, between them. Administration of antithrombotic drugs (ADs) was significantly higher in patients with insufficient evacuation of an IVH, and they showed an unfavorable prognosis on a univariate analysis (p = 0.008 and 0.040 respectively). There was a history of AD administration or thrombocytopenic disease (TD) in 72% of patients with insufficient evacuation and 5.0% of patients with non-insufficient evacuation (p = 0.001). Hematoma evacuation was difficult in 11 of 13 patients because of hardness, and ADs were used in 5 of those 11 patients. Hematoma evacuation was difficult in 11 of 42 patients in the first 2 days (26.2%) and 2 of 8 patients (25%) from 3 to 5 days. Five of 11 patients used ADs, and 1 of 11 had a TD within 2 days while there was no AD or TD between 3 and 5 days. There was no case of insufficient evacuation after 6 days.
Conclusions: Hematoma evacuation is difficult in patients with AD or TD, particularly within 5 days from onset. It is recommended that endoscopic evacuation be performed 6 days from onset, if surgery can be postponed.
