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BackgroundCerebellar hemorrhage is a severe cerebrovascular disease. The small posterior fossa space can cause compression of surrounding brain tissue with even a small amount of bleeding, leading to increased intracranial pressure, disruption of blood supply to surrounding brain tissue, and exacerbation of brain function damage. The most common surgical approach currently is craniotomy for hematoma evacuation, inevitably causing damage to surrounding nerves and blood vessels. In this study, we introduced C-arm CT scanning combined with simple laser device technology to assist in puncture drainage for cerebellar hemorrhage, aiming to improve the accuracy of surgery and maximize the protection of patients’ brain function, providing a physiological basis for better clinical prognosis.Materials and methodsFrom January 2023 to February 2024, a total of 8 patients (6 males, 2 females) with cerebellar hemorrhage underwent C-arm CT-assisted puncture therapy combined with a simple laser device at the affiliated hospital of Binzhou Medical University. Statistical analysis was performed on operation time, number of punctures, impact on important structures and vessels, postoperative hematoma clearance, complications, and neurological function recovery.ResultsAll 8 patients underwent the surgery smoothly without causing damage to important structures or blood vessels. There was no rebleeding intraoperatively. Among the 8 patients, 5 were discharged smoothly, while 3 patients opted to discontinue treatment and requested discharge. At the 3-month follow-up, 3 patients showed no ataxia, while 2 patients had impaired cerebellar motor function.ConclusionC-arm CT scanning combined with a simple laser device technology can accurately locate the position of the hematoma, effectively avoid important structures and vessels, reduce damage to surrounding normal brain tissue, and maximize the protection of normal brain tissue function. Real-time navigation and dynamic adjustments during surgery allow immediate access to imaging data postoperatively. It also has the advantages of being minimally invasive, highly precise, easy to operate, and short operation time, demonstrating high practicality and feasibility.

Minimally invasive puncture combined with urokinase is widely used in the treatment of hypertensive intracerebral hemorrhage (HICH). However, the appropriate frequency of urokinase following minimally invasive puncture in patients is still unclear. In total, 55 patients were enrolled in this study. According to the frequency of urokinase (10.0 ​× ​104 units) administration, 30 patients received urokinase at Q4h, while the other 25 patients received urokinase at Q8h. In the univariate analysis, preoperative GCS (p ​= ​0.0002), postoperative GCS (p ​= ​0.0007), the volume of residual hematoma (p ​= ​0.0179), and the frequency of urokinase (p ​= ​0.0110) were associated with unfavorable outcomes in patients with HICH in the basal ganglia. The multivariate analysis revealed that the frequency of urokinase was independently associated with unfavorable outcomes in patients with HICH in the basal ganglia (p ​= ​0.038, 1.109–35.380). The drainage time was significantly shorter in the Q4h group (14.17 ​± ​0.86 ​h) than in the Q8h group (27.36 ​± ​1.39 ​h) (p ​< ​0.0001). The GOS (4.37 ​± ​0.18), BI (75.52 ​± ​2.39), and mRS (1.67 ​± ​0.24) in the Q4h group were significantly ameliorated compared to those in the Q8h group (GOS 3.56 ​± ​0.18, BI 64.13 ​± ​2.22, and mRS 2.64 ​± ​0.28, respectively) (p ​= ​0.0004, p ​= ​0.0002, and p ​= ​0.0018) at 3 months of follow-up. Thus, minimally invasive puncture combined with urokinase is safe and efficient. Increasing the frequency of urokinase administration can produce faster and better postoperative recovery for patients with HICH in the basal ganglia. [ABSTRACT FROM AUTHOR]

Application value of the minimally invasive puncture and small bone window craniotomy in hypertensive intracerebral hemorrhage was investigated to explore the effects of the above treatment methods on motor-evoked potentials (MEPs) and postoperative rehemorrhage. Patients with hypertensive intracerebral hemorrhage who were admitted to Chengyang People's Hospital from March 2016 to December 2017 were selected and randomly divided into the minimally invasive group (n=40) and the craniotomy group (n=40). The minimally invasive group was treated with minimally invasive puncture and drainage for hematomas, while the craniotomy group received small bone window craniotomy for evacuation of hematomas. The clinical efficacy was compared between the two groups. At 28 days after operation, the Chinese scale of clinical neurological deficit of stroke patients (CSS) score in the minimally invasive group was lower than that in the craniotomy group (p<0.05). At 28 days after operation, the S-100β level in the minimally invasive group was lower than that in the craniotomy group (p<0.05). At 1 week after operation, 35 patients in the minimally invasive group were able to elicit MEP waveforms, and only 7 patients in the craniotomy group were able to elicit positive waveforms. At 2 weeks after operation, 40 patients in the minimally invasive group and 20 patients in the craniotomy group could elicit MEP waveforms, and the incubation period, central motor conduction time and amplitude in the former were significantly better than those in the latter (p<0.05). The operation time and length of hospital stay were shorter with more total expenses of hospitalization in the minimally invasive group compared to those in the craniotomy group (p<0.05). Compared with small bone window craniotomy, minimally invasive puncture can reduce serum S-100β level. Its advantages are obvious, so it is worthy of promotion and application. [ABSTRACT FROM AUTHOR]

ObjectiveTo investigate the characteristics and prognosis of brain abscess, and the effects of minimally invasive CT-guided puncture and antibiotic flushing for brain abscess. MethodsThe clinical data of 62 patients with cerebral abscesses from January 2001 to December 2017 in Zhongshan Peoples Hospital were analyzed retrospectively. Of 62 patients, 52 with brain abscesses were treated with CT-guided puncture and 10 were treated with surgical resection. ResultsIn minimally invasive group, 43 cases were cured and the cure rate was 82.7%. 6 cases improved and the improvement rate was 11.5%. In surgical resection group, 6 cases were cured and the cure rate was 60.0%. 3 cases improved and the improvement rate was 30.0%. Six patients died 3 for each group. ConclusionThe CT-guided minimally invasive puncture combined with antibiotic flushing for the treatment of brain abscess is simple, safe, and less traumatic, can obtain good therapeutic effect, and is worthy of clinical application. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive puncture and conventional craniotomy are both utilized in the treatment of spontaneous supratentorial hemorrhage. The purpose of this study is to review evidence that compares the safety and effectiveness of these two techniques., Methods: We searched EMBASE, Cochrane Library, Web of Science, and PubMed for studies published between 2000 and 2019 that compared the minimally invasive puncture procedure with the conventional craniotomy for the treatment of spontaneous supratentorial hemorrhage., Results: Seven trials (2 randomized control trials and 5 observational studies) with a total of 970 patients were included. The odds ratio indicated a statistically significant difference between the minimally invasive puncture and conventional craniotomy in terms of good functional outcome (OR 2.36, 90% CI 1.24-4.49). The minimally invasive puncture procedure was associated with lower mortality rates (OR 0.61, 90% CI 0.44-0.85) and rebleeding rates (OR 0.48, 95%CI 0.24-0.99; P=0.003)., Conclusions: The use of the minimally invasive puncture for the management of spontaneous supratentorial hemorrhage was associated with better functional outcome results, a lower mortality rate, and decreased rebleeding rates. However, because insufficient data has been published thus far, we need more robust evidence to provide a better guide for future management., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)