Introduction: We investigated the effect of hematoma volume reduction with minimally invasive surgery (MIS) on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in patients with large spontaneous intracerebral hemorrhage (ICH). Methods: Post-hoc analysis of the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation (MISTIE III) study, a clinical trial with blinded outcome assessments. The primary outcome was the proportion of ICP readings ≥20 and 30 mmHg, and CPP readings <70 and 60 mm Hg. Secondary outcomes included major disability (modified Rankin scale >3) and mortality at 30 and 365 days. We assessed the relationship between proportion of high ICP and low CPP events and MIS using binomial generalized linear models, and outcomes using multiple logistic regression. Results: Of 499 patients enrolled in MISTIE III, 72 patients had guideline based ICP monitors placed, 34 in the MIS group and 38 in control (no surgery) group. Threshold ICP and CPP events ≥20/ <70 mmHg occurred in 31 (43.1%) and 52 (72.2%) patients respectively. On adjusted analyses, proportion of ICP readings ≥20 and 30 mmHg were significantly lower in the MIS group vs. control group [Odds Ratio (OR) 0.27, 95% Confidence Interval [CI] 0.11-0.63 (p = 0.002); OR = 0.18, 0.04-0.75, p = 0.02], respectively. Proportion of CPP readings <70 and 60 mm Hg were also significantly lower in MIS patients [OR 0.31, 95% CI 0.15-0.63 (p = 0.001); OR 0.30, 95% CI 0.11-0.83 (p = 0.02)], respectively. Higher proportions of CPP readings <70 and 60 mm were significantly associated with short term mortality (p = 0.04), and (p = 0.006), respectively. Long term mortality was significantly associated with higher proportion of time with ICP ≥ 20 (p = 0.04), ICP ≥ 30 (p = 0.04), and CPP <70 mmHg (p = 0.01). Conclusion: Our results are consistent with the hypothesis that surgical reduction of ICH volume decreases proportion of high ICP and low CPP events and that these variables are associated with short- and long-term mortality.

中文翻译：

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大自发性颅内出血的颅内压和脑灌注压及微创手术的影响。

介绍：我们研究了微创手术 (MIS) 减少血肿体积对大自发性脑出血 (ICH) 患者颅内压 (ICP) 和脑灌注压 (CPP) 的影响。方法：微创手术加阿替普酶用于脑出血清除 (MISTIE III) 研究的事后分析，这是一项采用盲法结果评估的临床试验。主要结果是 ICP 读数 ≥ 20 和 30 mmHg 以及 CPP 读数 <70 和 60 mmHg 的比例。次要结果包括严重残疾（改良 Rankin 量表 >3）和 30 天和 365 天死亡率。我们使用二项式广义线性模型评估了高 ICP 和低 CPP 事件的比例与 MIS 之间的关系，并使用多元逻辑回归评估了结果。结果：在 499 名参加 MISTIE III 的患者中，72 名患者安装了基于指南的 ICP 监测器，34 名在 MIS 组，38 名在对照组（未手术）。阈值 ICP 和 CPP 事件≥20/<70 mmHg 分别发生在 31 (43.1%) 和 52 (72.2%) 名患者中。在调整后的分析中，与对照组相比，MIS 组 ICP 读数≥20 和 30 mmHg 的比例显着降低 [优势比 (OR) 0.27，95% 置信区间 [CI] 0.11-0.63 (p = 0.002)；OR = 0.18, 0.04-0.75, p = 0.02]，分别。MIS 患者中 CPP 读数 <70 和 60 mmHg 的比例也显着降低 [OR 0.31，95% CI 0.15-0.63 (p = 0.001)；OR 0.30, 95% CI 0.11-0.83 (p = 0.02)]，分别。较高比例的 CPP 读数 <70 和 60 mm 分别与短期死亡率 (p = 0.04) 和 (p = 0.006) 显着相关。长期死亡率与 ICP ≥ 20 (p = 0.04)、ICP ≥ 30 (p = 0.04) 和 CPP <70 mmHg (p = 0.01) 的较高时间比例显着相关。结论：我们的结果与手术减少 ICH 体积可降低高 ICP 和低 CPP 事件的比例的假设一致，并且这些变量与短期和长期死亡率相关。