新型国产16层移动CT辅助体表定位法徒手锥颅穿刺引流治疗幕上深部脑出血的实用性及置管准确度评估

Feasibility of free-handed conical craniotomy and drainage guided by novel 16-slice mobile CT-assisted surface projection in supratentorial intracerebral hemorrhage and accuracy of catheter placement

目的评估新型国产16层移动CT辅助体表定位法徒手锥颅穿刺引流治疗幕上深部脑出血的实用性,以及该术式置管的准确度。方法回顾性收集解放军总医院第七医学中心神经外科自2018年1月至2019年12月采用新型国产16层移动CT辅助体表定位法徒手锥颅穿刺引流治疗的52例幕上深部脑出血患者(徒手锥颅穿刺组)以及同期采用无框架立体定向穿刺引流治疗的30例幕上深部脑出血患者(立体定向穿刺组)的临床资料,分析移动CT检查效果及比较2组患者术后引流管相对偏离度(RE)的差异。结果徒手锥颅穿刺组患者均成功完成移动CT床旁扫描,图像均可满足指导体表定位的需求。徒手锥颅穿刺组、立体定向穿刺组患者中穿刺结果较满意即RE<1者比例分别为92.3%、90.0%,其中徒手锥颅穿刺组中1例进行了重复穿刺;徒手锥颅穿刺组与立体定向穿刺组患者术后RE(0.52±0.33 vs.0.53±0.29)差异无统计学意义(P>0.05);不同血肿位置、不同血肿量情况下,2组间RE差异亦无统计学意义(P>0.05)。结论新型国产16层移动CT辅助体表定位法徒手锥颅穿刺引流治疗幕上深部脑出血的效果良好,其置管准确度与无框架立体定向穿刺方式相当。

Objective To assess the feasibility of free-handed conical craniotomy and drainage guided by novel 16-slice mobile CT-assisted surface projection in patients with supratentorial intracerebral hemorrhage(sICH),and to evaluate the accuracy of catheter placement.Methods Fifty-two sICH patients received free-handed conical craniotomy and drainage guided by novel 16-slice mobile CT-assisted surface projection in our hospital from January 2018 to December 2019 were chosen(free-handed conical craniotomy group);30 sICH patients received frameless stereotactic puncture and drainage at the same time period were selected(stereotactic puncture group).The clinical data of these patients were retrospectively analyzed.The CT results were analyzed,and differences of relative error(RE)as the indicator of catheter placement accuracy were compared between the two groups.Results Mobile CT was successfully performed in all patients from free-handed conical craniotomy group,and sufficient information was provided for surface projection in all patients.The percentages of patients with satisfactory results of catheter placement(RE<1)in the free-handed conical craniotomy group and stereotactic puncture group were 92.3%and 90.0%;one patients from the free-handed conical craniotomy group had repeated puncture.There was no significant difference in postoperative RE between the two groups(0.52±0.33 vs.0.53±0.29,P>0.05).Subgroup analysis of different hematoma locations and volumes also showed no statistically significant difference in postoperative RE(P>0.05).Conclusion Free-handed conical craniotomy and drainage guided by novel 16-slice mobile CT-assisted surface projection is feasible in sICH patients,and the accuracy of catheter placement is similar with frameless stereotactic puncture and drainage.