The Application Of CTA Point Sign In The Selection Of Surgical Methods For Early Moderate Amount Of Cerebral Hemorrhage

Background and Objective:Intracerebral hemorrhage is one of the major diseases that endanger human life and health,with extremely high rate of disability and mortality.Surgical removal of intracranial hematoma is an effective method for the treatment of intracerebral hemorrhage.However,there are many methods for the treatment of intracerebral hemorrhage at present,and there is no unified standard for the selection of surgical methods.Imaging examination is an important method to understand the patient’s condition and evaluate the situation of hematoma.This article retrospectively analyzed the prognosis of patients with cerebral hemorrhage who received different surgical treatment with positive and negative CTA point signs,and discussed the application value of CTA point signs in guiding the selection of surgical methods for early moderate amount of cerebral hemorrhage.It is expected to provide some reference for the selection of surgical methods in the treatment of cerebral hemorrhage.Methods:This study retrospectively analyzed the clinical data of 257 patients with spontaneous intracerebral hemorrhage of equal volume(30-60ml)who were admitted to The Fifth Affiliated Hospital of Zhengzhou University for preoperative CTA examination from June 2015 to June 2020.According to the preoperative CTA examination results,they were divided into two groups:the CTA point-sign positive group(70 cases)and the CTA point-sign negative group(187 cases).In the CTA point sign positive group,39 cases underwent craniotomy for hematoma removal(positive craniotomy group)and 31 cases underwent minimally invasive puncture and drainage(positive drainage group).In the CTA point sign negative group,there were 84 cases of craniotomy hematoma removal(negative craniotomy group)and 103 cases of minimally invasive puncture and drainage(negative drainage group).The clinical data and 6-month follow-up data of patients were collected to compare the differences in complications,prognosis and mortality of patients receiving different surgical treatment between the positive and negative CTA point signs,and to explore the significance of CTA point signs in guiding the selection of surgical methods.Results:A total of 257 ICH patients were included in this study,including 70 patients with preoperative positive CTA and 187 patients with preoperative negative CTA.1.In the CTA positive group,there were 39 patients in the positive craniotomy group,including 23 males and 16 females,with an average age of 59 years;There were 31 patients in the positive drainage group(male 21,female 10,mean age 56years).There was no significant difference in baseline data between the two groups.In the CTA negative group,84 patients(54 males,30 females,mean age 59)were in the negative craniotomy group.There were 103 cases in the negative drainage group(63males,40 females,mean age 60 years).There was no significant difference in baseline data between the two groups.2.The univariate analysis showed that the positive group compared with the positive drainage of craniotomy,positive neural functional prognosis craniotomy group(P=0.015),and bleeding(P=0.000),intracranial infection(P=0.014)and mortality(P=0.003)were superior to drainage of positive,statistically significant differences,and hydrocephalus,pulmonary infection,urinary tract infection had no statistical difference.Comparison between negative craniotomy group and negative drainage group The neurological function prognosis of negative drainage group(P=0.023)was better than that of negative craniotomy group,the difference was statistically significant,but the intracranial infection rate of drainage group(P=0.036)was higher than that of negative craniotomy group.In addition,there were no statistical differences in rebleeding,hydrocephalus,pulmonary infection,urinary tract infection and mortality between the two groups.3.Kaplan-Meier survival analysis showed that there was no statistically significant difference in neurological prognosis between the positive group and the positive drainage group in the preoperative CTA point sign positive group(χ~2=0.194,P=0.660),but the survival rate at 6 months in the positive craniotomy group was significantly lower than that in the positive drainage group(χ~2=10.280,P=0.001).In the preoperative CTA point sign negative group,patients in the negative drainage group had better prognosis of neurological function than those in the negative craniotomy group(χ~2=5.024,P=0.025),but there was no statistically significant difference in the 6-month survival between the two groups(χ~2=2.113,P=0.146).Conclusions:1.CTA point sign of imaging examination is of great significance in guiding the selection of surgical methods for early moderate amount of cerebral hemorrhage.2.Craniotomy is better than minimally invasive puncture and drainage for patients with intracerebral hemorrhage with positive CTA point signs,while minimally invasive puncture and drainage is better for patients with negative CTA point signs.