Background

Decreased organ function and poor physical compensatory capacity in elderly patients diagnosed with spontaneous intracerebral hemorrhage (ICH) can make surgical treatment procedures challenging and risky. Minimally invasive puncture drainage (MIPD) combined with urokinase infusion therapy is a safe and feasible method of treating ICH. This study aimed to compare the treatment efficacy of MIPD conducted under local anesthesia using either 3DSlicer + Sina application or computer tomography (CT)–guided stereotactic localization of hematomas in elderly patients diagnosed with ICH.

Methods

The study sample included 78 elderly patients (≥ 65 years of age) diagnosed with ICH for the first time. All patients exhibited stable vital signs and underwent surgical treatment. The study sample was randomly divided into two groups, either receiving 3DSlicer+Sina or CT-guided stereotactic assistance. The preoperative preparation time; hematoma localization accuracy rate; satisfactory hematoma puncture rate; hematoma clearance rate; postoperative rebleeding rate; Glasgow Coma Scale (GCS) score after 7 days; and modified Rankin scale (mRS) score 6 months after surgery were compared between the two groups.

Results

No significant differences in gender, age, preoperative GCS score, preoperative hematoma volume (HV), and surgical duration were observed between the two groups (all p-values > 0.05). However, the preoperative preparation time was shorter in the group receiving 3DSlicer + Sina assistance compared to that receiving CT-guided stereotactic assistance (p-value < 0.001). Both groups exhibited significant improvement in GCS scores and reduction in HV after surgery (all p-values < 0.001). The accuracy of hematoma localization and puncture was 100% in both groups. There were no significant differences in surgical duration, postoperative hematoma clearance rate, rebleeding rate, postoperative GCS and mRS scores between the two groups (all p-values > 0.05).

Conclusions

A combination of 3DSlicer and Sina is effective in accurately identifying hematomas in elderly patients with ICH exhibiting stable vital signs, thus simplifying MIPD surgeries conducted under local anesthesia. This procedure may also be preferred over CT-guided stereotactic localization in clinical practice due to its ease of use and accuracy in hematoma localization.

中文翻译：

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3DSlicer与Sina在局麻下老年自发性脑出血微创穿刺引流术中的临床应用

背景

被诊断为自发性脑出血 (ICH) 的老年患者器官功能下降和身体代偿能力差会使手术治疗过程具有挑战性和风险。微创穿刺引流术（MIPD）联合尿激酶输注治疗是一种安全可行的治疗脑出血的方法。本研究旨在比较在诊断为 ICH 的老年患者中使用 3DSlicer + Sina 应用程序或计算机断层扫描 (CT) 引导的血肿立体定向定位在局部麻醉下进行 MIPD 的治疗效果。

方法

研究样本包括 78 名首次诊断为 ICH 的老年患者（≥ 65 岁）。所有患者均表现出稳定的生命体征并接受了手术治疗。研究样本被随机分为两组，接受 3DSlicer+Sina 或 CT 引导的立体定向辅助。术前准备时间；血肿定位准确率；满意的血肿穿刺率；血肿清除率；术后再出血率；7 天后格拉斯哥昏迷量表 (GCS) 评分；比较两组患者术后6个月的改良Rankin量表(mRS)评分。

结果

两组在性别、年龄、术前 GCS 评分、术前血肿体积 (HV) 和手术持续时间方面无显着差异（所有 p 值 > 0.05）。然而，与接受 CT 引导的立体定向辅助相比，接受 3DSlicer + Sina 辅助的组的术前准备时间更短（p 值 < 0.001）。两组在手术后均表现出 GCS 评分的显着改善和 HV 的降低（所有 p 值 < 0.001）。两组血肿定位穿刺准确率均为100%。两组间手术时间、术后血肿清除率、再出血率、术后 GCS 和 mRS 评分无显着差异（所有 p 值 > 0.05）。

结论

3DSlicer 和 Sina 的结合可以有效地准确识别生命体征稳定的老年 ICH 患者的血肿，从而简化在局部麻醉下进行的 MIPD 手术。由于其易用性和血肿定位的准确性，该程序在临床实践中也可能优于 CT 引导的立体定向定位。