• World Neurosurg · Jul 2019

    Does Non-Contrast CT Scan Predict Rebleeding after Endoscopic Surgery for Spontaneous Intracerebral Hemorrhage?

    • Kenji Yagi, Yoshifumi Tao, Keijirou Hara, Satoshi Hirai, Hiroki Takai, Keita Kinoshita, Naoki Oyama, Yoshiki Yagita, Shunji Matsubara, and Masaaki Uno.
    • Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan. Electronic address: kenji-yagi@mail.goo.ne.jp.
    • World Neurosurg. 2019 Jul 1; 127: e965-e971.

    BackgroundThe relationship between noncontrast computed tomography (CT) markers, which predict the expansion of spontaneous intracerebral hemorrhage (sICH) under conservative treatment, and postoperative rebleeding (PR) after treatment by directly removing the sICH is unknown. This study investigated the relationship between noncontrast CT markers and PR in patients with sICH treated by endoscopic surgery.MethodsThe study population included 92 patients with available data who underwent endoscopic surgery for sICH at our institution from January 2010 to September 2018. The correlations between PR and preoperative noncontrast CT markers, including the blend sign, hypodensities, black hole sign, heterogeneous density, and island signs, were retrospectively evaluated.ResultsIn 5 of the 18 patients (27.8%) with the blend sign, PR developed, whereas only 5 of 74 patients (6.8%) without the blend sign developed PR. In the univariate regression analyses, manifestation of hydrocephalus (odds ratio [OR], 8.75; 95% confidence interval [CI], 2.15-35.68; P = 0.002), presence of the blend sign (OR, 5.31; 95% CI, 1.34-20.97; P = 0.02), and insertion of external ventricular drainage (OR, 13.88; 95% CI, 3.22-59.77; P < 0.001) were significant risk factors. The other radiographic markers were not associated with PR. In a multivariate analysis, the presence of the blend sign (OR, 22.07; 95% CI, 2.18-223.60; P = 0.009) was the only independent predictor of PR.ConclusionsThe blend sign is likely to be a strong predictor for PR in patients who undergo endoscopic surgery for sICH. To improve the prognosis of patients with sICH, further studies are needed to establish new treatment strategies and surgical procedures.Copyright © 2019 Elsevier Inc. All rights reserved.

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