基底节及丘脑自发性脑出血非脑疝患者治疗决策相关临床与影像学评估研究进展

Research Progress on Clinical and Imaging Evaluation Related to Treatment Decision-Making in Patients with Spontaneous Cerebral Hemorrhage in Basal Ganglia and Thalamus and Non-Cerebral Hernia

摘要: 自发性脑出血(spontaneous intracerebral hemorrhage, sICH)是脑卒中中致死率和致残率最高的亚型之一，目前的有效治疗手段较有限。急诊去骨瓣减压联合血肿清除通常被认为是挽救发生脑疝患者生命的重要外科手段。然而，对于尚未出现脑疝并且意识状态相对稳定患者的最优治疗策略仍存在明显争议。在总体的sICH患者中，STICH系列研究未能证实传统开颅血肿清除术比保守治疗具有明确优势，但是近期ENRICH试验提示部分脑叶出血患者可能从早期微创手术中获益。这些结果都提示了手术带来的收益在不同亚群患者身上有较大的不同，对于非脑疝这类治疗患者精准筛选出受益人群可能是关键，而影像学评估以及sICH的一些评分系统在患者筛选及指导个体化手术方面中经常发挥重要作用。本文系统总结非脑疝sICH患者的一些重要临床评分系统及多模态影像学评估(NCCT、CTA、CTP及DTI)的研究进展，并探讨其在治疗决策中的临床意义。

Abstract: Spontaneous intracerebral hemorrhage (sICH) is one of the subtypes with the highest mortality and disability in stroke, and the current effective treatment is limited. Emergency decompressive craniectomy combined with hematoma removal is usually considered to be an important surgical method to save the life of patients with cerebral hernia. However, the optimal treatment strategy for patients without cerebral hernia and with relatively stable state of consciousness is still controversial. In the overall sICH patients, STICH series of studies have failed to confirm that traditional craniotomy hematoma removal has a clear advantage over conservative treatment, but recent ENRICH trials suggest that some patients with lobar hemorrhage may benefit from early minimally invasive surgery. These results suggest that the benefits of surgery are quite different in different subgroups of patients. It may be the key to accurately screen out the beneficiary population for patients with non-cerebral hernia treatment, and imaging evaluation and some scoring systems of sICH often play an important role in patient screening and guiding individualized surgery. This article systematically summarizes the research progress of some important clinical scoring systems and multimodal imaging evaluation (NCCT, CTA, CTP and DTI) in patients with non-cerebral hernia sICH, and discusses its clinical significance in treatment decision-making.