Predictive Factors Of Postoperative Cerebrospinal Fluid Outflow In Intracerebral Hemorrhage With Intraventricular Involvement Treated By Minimally Invasive Craniopuncture

Purpose: Our previous study found that postoperative cerebrospinal fluid(CSF)outflow was an independent factor associated with high hematoma evacuation efficiency in intracerebral hemorrhage with intraventricular involvement(ICHV)treated by minimally invasive craniopuncture(MIC).This study is designed to identify factors that can predict postoperative CSF outflow and profile a specific subtype of ICHV which may benefit from MIC.Methods: A total of 125 patients with supratentorial ICHV treated by MIC were analyzed retrospectively.Univariate analysis was used to screen out the suspicious predictive factors,and then all suspicious factors were included in a binary logistic regression model to identify independent predictors of postoperative CSF outflow.Results: Through univariate analysis,we found eight possible factors which may predict postoperative CSF outflow.Among them,three factors were determined as independent predictive factors by multivariate analysis.They were the mean CT number of the whole hematoma ?59HU(OR=8.572,95% CI: 3.235-22.714,P<0.001),the distance between needle tip and ventricular tear d1?21.79mm(OR=4.434,95% CI: 1.218-16.138,P=0.024),and the distance between needle tip and ventricular tear d2(21.79mm<d2?34.15mm)(OR=25.566,95% CI: 8.707-75.074,P<0.001).Standardization regression coefficients from large to small were: d2(B'=0.883),the mean CT number of the whole hematoma?59HU(B'=0.576)and d1(B'=0.313),Hence,d2 had the most influence on postoperative CSF outflow.The mean CT number of the hematoma within 34.15 mm from the tear(clot 3.4)had no statistical difference from the mean CT number of the whole hematoma(P=0.571).The mean CT number of clot 3.4?60HU was also a predictive factor of postoperative CSF outflow(AUC=0.771).Conclusions: The ICHV patients who can meet all the following conditions may benefit from MIC.(1)MIC needle tip can be placed in the hematoma 21.79-34.15 mm to the ventricular tear.(2)low CT number of the whole hematoma(?59HU).(3)low CT number of clot 3.4(?60HU).