Incidence and outcomes of intracerebral haemorrhage with mechanical compression hydrocephalus

Clinical characteristics and prognostic analysis of patients with hydrocephalus after hypertensive cerebral haemorrhage: a retrospective case-control study

To investigate the clinical characteristics of patients with hydrocephalus after hypertensive cerebral haemorrhage (HICH) and to analyse the relevant factors affecting the prognosis. A total of 500 patients with HICH admitted to the neurosurgery department of The First Hospital of Hebei Medical University between January 2020 and July 2024 were retrospectively analysed. The clinical data of the patients were collected, the occurrence of hydrocephalus within 3 months after discharge was followed up, and the patients were divided into the occurrence group and the non-occurrence group. Logistic regression analysis was applied to identify risk factors for hydrocephalus, and receiver operating characteristic (ROC) curves were used to evaluate the predictive value of these factors. Among 500 patients, 45 (9%) developed hydrocephalus, with an average age of 59.93 ± 14.20 years in the occurrence group and 61.76 ± 12.28 years in the non-occurrence group. Logistics univariate analysis showed that the brain haemorrhage location, cerebral hernia, haematoma volume and the Glasgow Coma Scale (GCS) score were the influencing factors for hydrocephalus after HICH (P < 0.05). The results of logistics multivariate analysis showed that cerebral hernia (odds ratio [OR] = 3.102, 95% CI: 1.315-7.204) and the GCS score (OR = 1.732. 95% CI: 1.102-2.401) were risk factors for the development of hydrocephalus after HICH (P < 0.05). The ROC curve analysis showed an area under the curve of 0.639 for cerebral hernia, 0.713 for the GCS score and 0.794 for their combination in predicting hydrocephalus. Cerebral hernia and the GCS score are independent influencing factors of hydrocephalus after HICH, and the combination of the two can better predict the formation of hydrocephalus.

Advantages of disposable portable endoscope in removing thalamic hematoma via the superior parietal lobule

OBJECTIVES

Thalamic hematoma patients present with diverse clinical conditions, and treatment approaches vary widely. Currently, the use of disposable portable endoscope surgery has been rapidly adopted in many hospitals, but outcomes can vary significantly. Surgical approaches and techniques for thalamic hematoma often reference those used for basal ganglia hemorrhage, but their effectiveness remains uncertain. This study aims to explore the advantages of using disposable portable endoscopes in removing thalamic hematoma via the superior parietal lobule, providing guidelines for clinicians to manage thalamic bleeding effectively.

METHODS

Clinical data of patients with thalamic hematoma who underwent either disposable portable endoscope or microscope surgery at the Third Xiangya Hospital, Central South University, were retrospectively analyzed. Surgical duration, hematoma clearance rate, length of hospital stay, improvement rate in Glasgow Coma Scale (GCS) score at 24 hours post-operation, and incidence of pulmonary infection were compared between the 2 groups.

RESULTS

Compared with the microscope group, the disposable portable endoscope group had shorter operation time, higher hematoma clearance rate, shorter hospital stay, and lower incidence of pulmonary infection (all P<0.05). However, there was no significant difference in the improvement rate of GCS score at 24 hours post-operation between the 2 groups (P>0.05).

CONCLUSIONS

In the surgical removal of thalamic hematoma via the superior parietal lobule, the disposable portable endoscope offers advantages such as shorter surgical duration, better visualization, higher hematoma clearance rate, improved surgical efficiency, shorter hospital stay, and lower incidence of pulmonary infection. Therefore, it can be considered as a preferred surgical treatment option for patients with thalamic hematoma.

A review of invasive intracranial pressure monitoring following surgery for hypertensive cerebral hemorrhage

Hypertensive cerebral hemorrhage, the most common prevalent of spontaneous cerebral hemorrhage, poses a significant threat to patient mortality and morbidity, while therapeutic options remain limited, making the disease a burden not only for patients' families but also a major challenge for national healthcare systems. The elevation of intracranial pressure subsequent to hypertensive cerebral hemorrhage is a critical contributor to mortality. However, it often manifests before the onset of clinical symptoms, which are typically atypical, leading to delayed treatment and irreversible consequences for the patient. Hence, early detection of intracranial pressure variations can aid in timely, efficient, and precise treatment, reducing patient mortality. Invasive intracranial pressure monitoring enables real-time, accurate monitoring of intracranial pressure changes, providing clinicians with therapeutic guidance and overcoming the limitations of empirical treatment. This article aims to review the use of invasive intracranial pressure monitoring in postoperative hypertensive cerebral hemorrhage and hopes to contribute to clinical and scientific research.

Apolipoprotein E Gene Polymorphism Effects on Lipid Metabolism and Risk of Cerebral Infarction in Northwest Han Chinese Population

Background

The apolipoprotein E (ApoE) genetic variation may contribute to the development of Cerebral Infarction (CI). Serum lipid levels are known risk factors for CI, but the effect of the ApoE gene polymorphism on lipid metabolism remains unclear. This retrospective cohort study was designed to determine the role of ApoE genotypes in CI risk and the relationships between ApoE gene polymorphism and serum lipid levels among the population of northwest China.

Patients and Methods

517 CI patients and 517 non-CI controls were enrolled in the study. Polymerase chain reaction and hybridization were utilized to determine the ApoE gene polymorphisms.

Results

The ε3/ε4 genotype and ε4 allele frequency were significantly higher in CI patients than in controls. When stratified by age and sex, statistically significant differences in the distribution and frequency of the ε3/ε4 genotype and ε4 allele were found between patients and controls. Compared to ε2 carriers, ε4 carriers had significantly lower ApoE levels and higher low-density lipoprotein cholesterol (LDL-C), ApoB and ApoB/ApoA-I levels in both two groups. Additionally, control participants with ε4 carriers had significantly higher levels of lipoprotein and total cholesterol (TC) levels than ε2 carriers, while CI patients with ε4 carriers had a significantly lower level of ApoA-I. After adjusting for other established risk factors, drinking, hypertension, lipoprotein, triglycerides (TG) and ε4 allele were significant independent risk factors for CI, which was shown to be associated with a nearly two-fold CI risk.

Conclusion

This study demonstrated that ε4 allele is independent risk factors for CI among patients in Northwest China. ApoE polymorphism was associated with CI, which was partly mediated through blood lipids and may also be mediated through non-lipid pathways. These data might be of great clinical significance in individualized preventive and therapeutic strategies.

Associations of MTHFR gene polymorphism with lipid metabolism and risk of cerebral infarction in the Northwest Han Chinese population

Objective

Genetic variation in the methylenetetrahydrofolate reductase (MTHFR) gene may contribute to the development of cerebral infarction (CI); however, results have been inconsistent across studies with different populations, including studies of the Chinese population. The aim of this study was to analyze the effect of MTHFR gene polymorphism on serum lipid and homocysteine levels among patients with CI in the Northwest Chinese Han population.

Patients and methods

A total of 521 CI patients and 524 non-CI controls were enrolled in the study. Polymerase chain reaction and hybridization were utilized to identify MTHFR gene polymorphisms. Multivariate logistic regression analysis was used to assess the associations of MTHFR gene polymorphism with risk of CI.

Results

Frequencies of the TT genotype and the T allele were markedly higher among CI patients than among controls. After stratifying our data by sex and age, we determined that these differences in frequency of the TT genotype and the T allele were statistically significant among participants of two different age brackets and among men, but not among women (i.e., there were no statistically significant differences between female patients and female controls). CI patients and control participants with the CT or TT genotype had significantly higher homocysteine (Hcy) levels than those with the CC genotype. Among CI patients, CT/TT carriers showed significantly lower high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A-I (ApoA-I) levels as compared with CC carriers, but there was no significant difference for control participants. Multivariable logistic regression analysis showed that drinking; smoking; diabetes mellitus; levels of Hcy, direct bilirubin (DB), indirect bilirubin (IB), ApoA-I, and total protein (TP); and TT genotype were significant independent risk factors for CI.

Conclusions

The results suggested that the TT genotype of the MTHFR C677T gene polymorphism, which is associated with hyperhomocysteinemia (HHcy), might be of great clinical significance in the identification of new biomarkers for CI and in the development of individualized preventive and therapeutic strategies.

Combined External Ventricular Drainage and Endoscope-Assisted Microsurgery Using the Middle Frontal Gyrus Approach in Severe Ventricular Hemorrhage with Casting of the Fourth Ventricle

OBJECTIVE

To investigate combined external ventricular drainage and endoscope-assisted microsurgery using the middle frontal gyrus approach in patients with severe ventricular hemorrhage with casting of the fourth ventricle and patients' recovery after this treatment.

METHODS

Patients with severe ventricular hemorrhage with casting of the fourth ventricle (n = 41) were randomly assigned to intervention and control groups. Modified Graeb score was used to assess 3-day hematoma clearance rate before and after surgery, drainage tube extubation time for the 2 groups was compared, and time when blood clot in the fourth ventricle was not blocked with cerebrospinal fluid was compared. Glasgow Coma Scale was used to assess consciousness after surgery; Glasgow Coma Scale scores recorded 1 and 7 days after surgery were also compared. Modified Rankin Scale was used to evaluate patients' recovery 1 and 6 months after surgery. Hydrocephalus and intracranial infections in patients after surgery were recorded for 90 days.

RESULTS

The 3-day hematoma clearance rate was dramatically higher in the intervention group. Modified Graeb score showed that more hemorrhage was delimited in 3 days in the intervention group. The intervention group exhibited significantly reduced length of block of the fourth ventricle and drainage tube extubation time. High Glasgow Coma Scale and modified Rankin Scale scores and significantly low incidence of complications (e.g., hydrocephalus and intracranial infection) were observed in patients in the intervention group.

CONCLUSIONS

Combined external ventricular drainage and endoscope-assisted microsurgery using the middle frontal gyrus approach can effectively improve severe ventricular hemorrhage with casting of the fourth ventricle and enhance patients' neurological function and recovery.