CTA spot sign predicts hematoma removal surgery after bleeding

Ref: Miki K, et alJ Neurosurg2018 May 25:1-6doi: 10.3171/2017.12.JNS172335spontaneous cerebral hemorrhage (sICH) is the most destructive type of cerebrovascular diseaseThe results of several clinical randomized trials show that open cranial surgery can prevent the occurrence of secondary brain injury, but the operation itself can also bring some harm, affecting the patient's prognosisMicroinvasive surgery, such as endoscopy hematoma removal, has been applied to sICH and is expected to improve surgical efficacyHowever, postoperative rehealation (PRH) is one of the serious complications after hematoma removalThe speckled signs on CTA are risk factors for hematoma enlargement and PRHKoichi Miki of Neurosurgery at Fukuoka University in Japan and others studied whether spot signs were associated with PRH after endoscopic hematoma removal, published online in May 2018retrospective of the study included 127 patients with sICH who performed endoscopic hematoma removal in the authors' unit between June 2009 and March 2017Collected data on patients' age, sex, hypertension, diabetes, smoking, clotting disorder, daily alcohol consumption, platelet reduction, bleeding, antiplatelet therapy, anticoagulant therapy, median GCS score, hematoma location, preoperative imaging characteristics (including black hole signs, mixed signs, and spots, etc.) and whether PRH occurredThe correlation between PRH and various factors was analyzed using the multi-logistic regression modelThe results showed that speckle signs were independent predictors of PRH (OR-5.81; 95% CI, 1.26-26.88; P-0.02), and the remaining factors were not independently correlated with PRHTherefore, the author points out that the speckled signs on CTA in patients with sICH are important predictors of PRH after endoscopic hematoma removal, and that patients should ensure adequate hematoma stop in the hematoma cavity when performing endoscopic hematoma removalDuring the operation, physiological saline or artificial cerebrospinal fluid can be injected and hematoma cavity can be filled to find bleeding points to stop the bleeding point, or under the guidance of the navigation system to locate the ruptured small blood vessels indicated by the speckle sign and stop the bleedingThe use of coagulation factors can also be effectiveTable 1Analysis of various predictors of postoperative bleeding of hematoma removal in the endoscopic mirror(Anhai Hospital
LYcompiled, editor-in-chief of "Outside The God Information" and editor-in-chief of Fudan University's affiliated Huashan HospitalProfessor Chen Chengcheng)relevant links