基于DTI评估内镜经额入路与经颞入路手术治疗基底节脑出血的预后研究

Evaluation of endoscopic transfrontal and transtemporal approaches based on DTI prognostic study on surgical treatment of basal ganglia cerebral hemorrhage

目的 通过磁共振弥散张量成像技术(DTI)评价内镜经额入路和经颞入路治疗基底节区脑出血的优劣性,进一步探讨其临床意义。方法 回顾性分析2020年6月—2021年5月陕西省人民医院神经外科收治的65例基底节区脑出血患者,分为A、B两组。A组(33例)内镜经额入路进入血肿腔,B组(32例)经颞入路进入血肿腔。所有患者在术后2周、术后6个月分别行两次DTI检查,通过重建皮质脊髓束(CST)观察双侧CST的性状,并测量双侧FA值及CST数量。对术后2周患侧FA值及MAS运动功能评分进行相关性分析,并通过ROC曲线预测患侧FA值和CST数量与经颞叶入路手术治疗基底节脑出血的关系。结果 两组术前资料比较,差异无统计学意义。组间比较:术后2周、术后6个月,A组患侧FA值高于B组,差异具有统计学意义(P<0.05);术后2周,A组患侧CST数量高于B组,差异具有统计学意义(P<0.05);组内比较:术后6个月A、B组患侧FA值高于术后2周,差异具有统计学意义(P<0.05)。术后2周患侧FA值与术后6个月MAS运动功能评分之间具有较高正相关性(A组:r^(2)=0.649 3,P<0.000 1;B组:r^(2)=0.934 7,P<0.000 1)。通过ROC曲线对FA值和CST数量进行预测的结果,FA值的AUC=0.696(95%CI=0.569~0.823);CST数量的AUC=0.591(95%CI=0.451~0.731)。结论 DTI可以较好地评价高血压脑出血患者CST损伤程度,FA值与CST数量均可用于预测两种手术入路预后,其中FA值预测效果更好。DTI还可以作为评估基底节脑出血患者远期运动神经功能恢复的可靠指标,且术后2周患侧FA值越高,6个月后运动功能恢复越好。

Objective To evaluate the pros and cons of endoscopic transfrontal approach and transtemporal approach in the treatment of cerebral hemorrhage in basal ganglia based on diffusion tensor imaging(DTI), and to further explore its clinical significance. Methods 65 patients with cerebral hemorrhage in basal ganglia admitted by Department of Neurosurgery, Shaanxi Provincial People’s Hospital from June 2020 to May 2021 were analyzed retrospectively, which were divided into group A and group B. Group A(33 cases) performed endoscopic frontal approach, while group B(32 cases) via temporal approach. All patients underwent DTI twice at 2 weeks and 6 months after operation, and the characteristics of bilateral corticospinal tracts(CST) were observed by reconstructing CST, and the FA values of bilateral CST were measured. The correlation between FA value and MAS motor function score was analyzed 2 weeks after operation. Results There was no significant difference in preoperative data between the two groups. Comparison between groups: 2weeks and 6 months after operation,the FA value of the affected side in group A was higher than that in group B,and the difference was statistically significant( P < 0. 05). At 2 weeks after operation,the number of CST on the affected side of group A was higher than that of group B,and the difference was statistically significant( P < 0. 05). Intra-group comparison: The FA value of the affected side in group A and B at 6 months after operation was higher than that at 2 weeks after operation,and the difference was statistically significant( P < 0. 05). There was a high positive correlation between the FA value of the affected side at 2 weeks after operation and the MAS motor function score at 6 months after operation( group A: r^(2)= 0. 649 3,P < 0. 000 1,group B: r^(2)= 0. 9347,P < 0. 000 1). ROC curve was used to predict FA and CST,AUC of FA was 0. 696( 95% CI =0. 569 ~ 0. 823),AUC of CST number was 0. 591( 95% CI = 0. 451 ~ 0. 731). Conclusions DTI can better evaluate the extent of CST injury in patients with hypertensive cerebral hemorrhage. Both FA value and CST number can be used to predict the prognosis of two surgical approaches,and FA value has better prediction effect. DTI can also be used as a reliable index to evaluate the long-term recovery of motor nerve function in patients with basal ganglia hemorrhage,and the higher the FA value of the affected side at 2 weeks after operation,the better the recovery of motor function after 6months.