原发性脑干出血诊断与治疗历史、现状与未来

doi:10.3969/j.issn.1672-6731.2021.02.002

摘要/Abstract

摘要：

原发性脑干出血是全部脑出血类型中预后最差的亚型。目前尚缺乏统一的诊断标准，主要依靠高血压病史、临床表现和影像学特点，同时排除脑血管结构性病变和瘤卒中。其治疗仍存争议，欧美国家主张保守治疗，亚洲包括中国、韩国和日本等国家则在外科手术治疗方面进行了大量研究。目前原发性脑干出血的研究进展缓慢，主要缺乏高质量的临床研究，未来希望通过多中心队列研究或随机对照试验进一步明确最佳治疗方案。

关键词: 脑出血, 脑干, 神经外科手术, 综述

Abstract:

Primary brainstem hemorrhage (PBSH) has the worst outcome among all types of spontaneous intracerebral hemorrhage (SICH). There is no standardized criteria to diagnose PBSH. Generally, the diagnosis of PBSH is based on the history of hypertension, the clinical and radiological features after excluding other bleeding etiologies such as aneurysm, arteriovenous malformation, cavernomas and tumor apoplexy within brainstem. The management of PBSH remains controversial. Conservative and supportive treatment is given in most western countries where surgery is considered not to improve consciousness and other neurological functions. However, Asian countries such as China, Korea and Japan make a great contribution in surgical management of PBSH, emphasizing the lifesaving role of surgery. The current study of PBSH progresses very slow due to the lack of high-level clinical trial. In the future, multicenter cohort or randomized clinical study may guide the best way to deal with PBSH.

Key words: Cerebral hemorrhage, Brain stem, Neurosurgical procedures, Review

游潮, 陶传元. 原发性脑干出血诊断与治疗历史、现状与未来[J]. 中国现代神经疾病杂志, 2021, 21(2): 71-75.

YOU Chao, TAO Chuan-yuan. History, present and future of diagnosis and treatment of primary brainstem hemorrhage[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2021, 21(2): 71-75.

http://journal11.magtechjournal.com/cjcnn/CN/Y2021/V21/I2/71

参考文献

[1] Wang SS, Yang Y, Velz J, Keller E, Luft AR, Regli L, Neidert MC, Bozinov O. Management of brainstem haemorrhages[J]. Swiss Med Wkly, 2019, 149:w20062.
[2] Cheyne J, Underwood T. Cases of apoplexy and lethargy[M]. London:Thomas Underwood, 1812:4.
[3] Arseni C, Staneiu M. Primary haematomas of the brain stem[J]. Acta Neurochir (Wien), 1973, 28:323-330.
[4] Környey S. Rapidly fatal pontile hemorrhage[J]. Archi Neur Psych, 1939, 41:793-799.
[5] Mangiardi JR, Epstein FJ. Brainstem haematomas:review of the literature and presentation of five new cases[J]. J Neurol Neurosurg Psychiatry, 1988, 51:966-976.
[6] Takahama H, Morii K, Sato M, Sekiguchi K, Sato S. Stereotactic aspiration in hypertensive pontine hemorrhage:comparative study with conservative therapy[J]. No Shinkei Geka, 1989, 17:733-739.
[7] Hong J, Choi S, Kye DK, Park CK, Lee S, Kang J. Surgical outcome of hypertensive pontine hemorrhages:experience of 13 cases[J]. J Korean Neurosurg Soc, 1998, 27:59-65.
[8] Chung CS, Park CH. Primary pontine hemorrhage:a new CT classification[J]. Neurology, 1992, 42:830-834.
[9] Huang K, Ji Z, Sun L, Gao X, Lin S, Liu T, Xie S, Zhang Q, Xian W, Zhou S, Gu Y, Wu Y, Wang S, Lin Z, Pan S. Development and validation of a grading scale for primary pontine hemorrhage[J]. Stroke, 2017, 48:63-69.
[10] Shrestha BK, Ma L, Lan Z, Li H, You C. Surgical management of spontaneous hypertensive brainstem hemorrhage[J]. Interdisciplinary Neurosurgery, 2015, 2:145-148.
[11] Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, Fung GL, Goldstein JN, Macdonald RL, Mitchell PH, Scott PA, Selim MH, Woo D; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology. Guidelines for the management of spontaneous intracerebral hemorrhage:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2015, 46:2032-2060.
[12] Chen LH, Wei Q, Xu RX, Li YJ, Li WD, Zhao H, Gao JB, Yu B, Zhang HD. Minimal invasive surgical treatment of primary hypertensive brainstem hemorrhage[J]. Lin Chuang Shen Jing Wai Ke Za Zhi, 2015, 12:349-353.[陈立华, 魏群, 徐如祥, 李运军, 李文德, 赵浩, 高进宝, 于斌, 张洪钿. 原发性高血压脑干出血的微创手术治疗[J]. 临床神经外科杂志, 2015, 12:349-353.]
[13] Shi H, Zhou H, Wang FY, Sun WY, Ma K, Xue F, Liu F. Surgical treatment of hypertensive pontine hemorrhage through transtelovelar approach[J]. Lin Chuang Shen Jing Wai Ke Za Zhi, 2017, 14:49-51.[施辉, 周辉, 王富元, 孙维晔, 马逵, 薛峰, 刘飞. 经膜髓帆入路手术治疗桥脑高血压相关性脑出血[J]. 临床神经外科杂志, 2017, 14:49-51.]
[14] Xu ZJ, Xu H, Yu DF, Yang F, Zhou GZ. Surgical treatment of hypertensive brainstem hemorrhage via infratemporal-prepetrosal approach[J]. Lin Chuang Shen Jing Wai Ke Za Zhi, 2019, 16:497-499.[许志剑, 徐虎, 余丹枫, 杨帆, 周格知. 经颞下岩前入路手术治疗高血压性脑干出血[J]. 临床神经外科杂志, 2019, 16:497-499.]
[15] Li H, Liu WK, Lin S, You C. Treatment of hypertensive brainstem hemorrhage[J]. Zhonghua Shen Jing Wai Ke Za Zhi, 2013, 29:339-341.[李浩, 刘文科, 林森, 游潮. 高血压相关性脑干出血的治疗探讨[J]. 中华神经外科杂志, 2013, 29:339-341.]
[16] Liang YH, Zhou Y, Xu TW, Liu HD, Hu KQ, Chen F, Xie JL. The use of neuroelectrophysiological monitoring in surgical treatment of brainstem hemorrhage[J]. Zhongguo Lin Chuang Shen Jing Wai Ke Za Zhi, 2014, 19:229-230.[粱玉红, 周毅, 徐廷伟, 刘汉东, 胡克琦, 陈锋, 谢俊兰. 神经电生理监测在脑干出血手术中的应用[J]. 中国临床神经外科杂志, 2014, 19:229-230.]
[17] Xu F, Tao YQ, Sun X, Yang XW, Wang Y, Xu MT, Wang JH, Fei S, Wang TT. Robot of Stereotactic Assistant system assisted stereotactic surgery for the treatment of hypertensive brainstem hemorrhage[J]. Zhongguo Wei Qin Xi Shen Jing Wai Ke Za Zhi, 2017, 22:54-56.[许峰, 陶英群, 孙霄, 杨兴旺, 王宇, 徐梦婷, 王俊和, 费爽, 王婷婷. ROSA辅助定向手术治疗高血压性脑干出血[J]. 中国微侵袭神经外科杂志, 2017, 22:54-56.]
[18] Liang JG, Dong J, Qu MQ, Mao YQ. Endoscope-assisted microscopic surgery of brainstem hemorrhage with hematoma breaking into the forth ventricle[J]. Zhonghua Shen Jing Yi Xue Za Zhi, 2013, 12:197-199.[梁建广, 董军, 屈鸣麒, 毛永强. 神经内镜辅助手术治疗脑干出血破入第四脑室[J]. 中华神经医学杂志, 2013, 12:197-199.]
[19] Li LY. Perioperative nursing for patiens with severe brainstem hemorrhage after minimal invasive surgery[J]. Zhongguo Shi Yong Shen Jing Ji Bing Za Zhi, 2014, 17:105-106.[李丽艳. 重型脑干出血患者行显微外科治疗的围手术期护理[J]. 中国实用神经疾病杂志, 2014, 17:105-106.]
[20] Liu X, Li H, Hu X, Zheng J, You C. Discussion on treatment of spontaneous brainstem hemorrhage[J]. Lin Chuang Shen Jing Wai Ke Za Zhi, 2013, 10:287-288.[刘辛, 李浩, 胡鑫, 郑峻, 游潮. 自发性脑干出血治疗探讨[J]. 临床神经外科杂志, 2013, 10:287-288.]
[21] Jang JH, Song YG, Kim YZ. Predictors of 30-day mortality and 90-day functional recovery after primary pontine hemorrhage[J]. J Korean Med Sci, 2011, 26:100-107.
[22] Lan Z, Richard S, Hao L, Chen M, You C. Spontaneous hypertensive brainstem hemorrhage:does surgery benefit the severe cases[J]? Interdisciplinary Neurosurgery, 2019, 15:66-70.
[23] Liu FQ, Wang ZF, Yu XB, Zheng J, Zhang Y, Chen G, Zhang JM. Efficiency and influence factors of stereotactic precision aspiration in the treatment of primary brain stem hemorrhage[J]. Zhonghua Shen Jing Wai Ke Za Zhi, 2019, 35:1094-1098.[刘凤强, 王泽锋, 俞晓波, 郑建, 章杨, 陈高, 张建民. 立体定向精准抽吸治疗原发性脑干出血的疗效及其影响因素分析[J]. 中华神经外科杂志, 2019, 35:1094-1098.]
[24] Wang Q, Guo W, Liu Y, Shao W, Li M, Li Z, Li C, Li Z. Application of a 3D-Printed navigation mold in puncture drainage for brainstem hemorrhage[J]. J Surg Res, 2020, 245:99-106.
[25] Houlden DA, Li C, Schwartz ML, Katic M. Median nerve somatosensory evoked potentials and the glasgow coma scale as predictors of outcome in comatose patients with head injuries[J]. Neurosurgery, 1990, 27:701-707.
[26] Tao C, Zhang R, Hu X, Song L, Wang C, Gao F, You C. A novel brainstem hemorrhage model by autologous blood infusion in rat:white matter injury, magnetic resonance imaging, and neurobehavioral features[J]. J Stroke Cerebrovasc Dis, 2016, 25:1102-1109.
[27] Chen L, Chen T, Mao GS, Chen BD, Li MC, Zhang HB, Xi HT, She XC, Tang ZP, Zhang P, Zhang ZQ, Cong L, Bao YJ, Yang XF, Zhao SY, He C, Wen L, Zhang P, Xue MZ; On behalf of Chinese Association of Neururestoratology (Preparatoty) and China Committee of International Association of Neurorestoratology. Clinical neurorestorative therapeutic guideline for brainstem hemorrhage (2020 China version)[J]. J Neurorestoratol, 2020, 8:232-240.
[28] van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin:a systematic review and meta-analysis[J]. Lancet Neurol, 2010, 9:167-176.

选择文件类型/文献管理软件名称

选择包含的内容

2 原发性脑干出血诊断与治疗历史、现状与未来

History, present and future of diagnosis and treatment of primary brainstem hemorrhage

RichHTML

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	薛蓉, 张轩. 睡眠障碍对脑血管病的影响[J]. 中国现代神经疾病杂志, 2023, 23(8): 659-662.
[2]	张鹏, 陈涛, 许莉. 成人失眠认知行为疗法关键技术与流程改进建议[J]. 中国现代神经疾病杂志, 2023, 23(8): 663-667.
[3]	张轩, 薛蓉. 特发性快速眼动睡眠期行为障碍向神经系统变性疾病转化的生物学标志物研究进展[J]. 中国现代神经疾病杂志, 2023, 23(8): 668-673.
[4]	刘引, 汤永红, 翟锦霞, 邱媛. 慢性低度炎症与睡眠障碍研究进展[J]. 中国现代神经疾病杂志, 2023, 23(8): 674-677.
[5]	于洁洋, 张亚男, 李惠敏, 黄真灿, 李宛儒, 王赞. 发作性睡病与焦虑研究进展[J]. 中国现代神经疾病杂志, 2023, 23(8): 678-682.
[6]	库成心, 邓丽影, 谢亮. 缺血性卒中继发日间过度思睡研究进展[J]. 中国现代神经疾病杂志, 2023, 23(8): 683-686.
[7]	姜佳凤, 赵莲花, 赵伟. 褪黑素在阿尔茨海默病病理损害机制中的作用[J]. 中国现代神经疾病杂志, 2023, 23(8): 687-692.
[8]	黄沛, 王刚. 功能性帕金森综合征诊断与治疗[J]. 中国现代神经疾病杂志, 2023, 23(8): 738-741.
[9]	洪涛, 唐斌. 如何成为一名优秀的颅底外科医师[J]. 中国现代神经疾病杂志, 2023, 23(7): 571-574.
[10]	张晨, 张延铭, 佟小光. 内镜下经鼻入路联合显微镜下开颅手术治疗复杂鼻颅沟通颅底肿瘤初探[J]. 中国现代神经疾病杂志, 2023, 23(7): 575-579.
[11]	张庆硕, 宋丹丹, 周世越, 张金璐, 韩晓旭, 许顺良. 功能性步态障碍诊断与治疗[J]. 中国现代神经疾病杂志, 2023, 23(7): 604-609.
[12]	魏民, 詹琪佳, 蒋文彬, 李森, 刘晨, 肖波. 内镜下颅缝条状切除术治疗矢状缝早闭疗效分析[J]. 中国现代神经疾病杂志, 2023, 23(7): 621-626.
[13]	潘希娟, 邢英琦, 刘玉梅. 脑小血管病影像学评分方法[J]. 中国现代神经疾病杂志, 2023, 23(7): 633-637.
[14]	俞淑凤, 李宁, 徐健, 王鹏. 颈动脉漂浮血栓相关缺血性卒中诊断与治疗进展[J]. 中国现代神经疾病杂志, 2023, 23(7): 638-642.
[15]	魏俊吉. 神经外科重症医学规范化诊断与治疗[J]. 中国现代神经疾病杂志, 2023, 23(6): 477-478.

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

2 原发性脑干出血诊断与治疗历史、现状与未来

History, present and future of diagnosis and treatment of primary brainstem hemorrhage

RichHTML

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价