Intraoperative Active Bleeding in Endoscopic Surgery for Spontaneous Intracerebral Hemorrhage is Predicted by the Spot Sign

• Published in: World neurosurgery 2018-08, Vol.116, p.e513-e518
• Main Authors: Miki, Koichi, Yagi, Kenji, Nonaka, Masani, Iwaasa, Mitsutoshi, Abe, Hiroshi, Morishita, Takashi, Arima, Hisatomi, Inoue, Tooru
• Format: Article
• Language: English
• Subjects: Endoscopic surgery; Intracerebral hemorrhage; Intraoperative bleeding; Recurrent hemorrhage; Spot sign
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.05.022

Endoscopic evacuation of hematoma (EEH) has recently been applied to treat patients with spontaneous intracerebral hemorrhage (sICH). Intraoperative active bleeding (IAB), which is occasionally observed in EEH, might lead to greater blood loss, further brain damage, and more postoperative recurrent hemorrhage. However, no definite predictor of IAB has been established. Because the spot sign is associated with other hemorrhagic complications, we aimed to evaluate whether it predicts IAB. We retrospectively assessed the incidence and risk factors of IAB, including the spot sign, in 127 sICH patients who underwent EEH within 6 hours after computed tomography angiography at our institution between June 2009 and December 2017. The study included 53 women and 74 men with an average age of 66.7 ± 11.8 years. IAB occurred in 40 (31.5%) of the 127 patients, and it was more frequent in patients with the spot sign than in patients without it (14/24 [58.3%] vs. 26/103 [25.2%]; P = 0.003). Multivariable regression analyses suggested that the spot sign was an independent predictor of IAB (odds ratio [OR], 3.02; 95% confidence interval [CI], 1.10–8.30; P = 0.03). In addition, earlier surgery gradually increased the risk of IAB, and surgery within 4 hours of onset was an independent risk factor (OR, 4.34; 95% CI, 1.12–16.9; P = 0.03, referring to postonset 8 hours or more). The spot sign and early surgery were independent predictors of IAB in EEH for sICH. In patients with sICH and spot sign, complete treatment of IAB by electrocoagulation might be important for minimizing surgical complications. •The spot sign and early surgery are independent predictors of intraoperative active bleeding.•Completely treating culprit vessels might reduce surgical complications.•Immature or delayed sealing at the ruptured vessel contributes to spot sign formation.