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脑内出血的最小侵入性疏散:在ENRICH之后的现实实践和前景

Diego Incontri¹, Christopher Paul Kellner², Alexandros Polymeris¹

¹Neurology, Stroke Division, Harvard Medical School / Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.

Journal of neurointerventional surgery

|July 7, 2025

概括

针对脑内出血 (ICH) 的最小侵入性血瘤疏散 (MIE) 显示了实践的变化. 需要进一步的试验和合作,以确定MIE的益处,并优化患者选择进行手术干预.

科学领域:

神经外科神经外科
神经学神经学
临界护理医学临界护理医学

背景情况:

脑内出血的早期最小侵入性切除 (ENRICH) 试验激发了对脑内出血 (ICH) 的最小侵入性血瘤疏散 (MIE) 的兴趣.
目前ICH手术管理的临床实践仍有变化,ENRICH试验对实践的具体影响尚不清楚.

研究的目的:

调查管理ICH的临床医生,了解当前的MIE实践和观点.
评估ENRICH试验对临床决策对ICH的MIE的影响.

主要方法:

一项调查分发给血管神经病学家,神经强化专家和管理ICH患者的神经外科医生.
收集和分析了123个回复,以确定MIE采用趋势和影响因素.

主要成果:

50%的受访者报告说,ENRICH后的实践发生了变化,大多数人使用各种技术对选择的ICH患者进行了MIE.
专家之间缺乏共识,设备成本/可用性,ICH位置和患者的功能状态显著影响MIE决策.
76%的受访者要求进行进一步的试验,以确认MIE的好处,特别是对于lobar ICH.

结论:

关于ICH的MIE存在显著的变化和缺乏跨学科共识.
血管神经科医生和神经外科医生的加强合作至关重要.
需要进行额外的随机试验,以加强MIE在ICH管理中的证据基础.

关键词:

发生出血发生出血干预干预干预一次性中风,中风.

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