Chuhua Fu1, Ning Wang1, Bo Chen1, Pingli Wang1, Huayun Chen1, Wangwang Liu1, Lijun Liu2. 1. Department of Neurosurgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China. 2. Department of Neurosurgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China. Electronic address: 87848946@qq.com.
Abstract
OBJECTIVE: To date, no standard surgical procedure has been proven effective for intracerebral hemorrhage (ICH), particularly deep hematomas. This retrospective study evaluated the effectiveness and safety of endoscopic surgery, minimally invasive puncture and drainage, and craniotomy for treating moderate basal ganglia ICH. METHODS: Patients with basal ganglia ICH (N = 177) were divided into 3 groups based on therapeutic intervention as follows: endoscopic surgery group (n = 61), minimally invasive puncture and drainage group (n = 60), and craniotomy group (n = 56). Patient characteristics at admission were recorded. Operative time; blood loss during operation; evacuation rate; postoperative complications secondary to perihematomal edema, including rebleeding, infectious meningitis, pulmonary infection, gastrointestinal bleeding, and epilepsy; mortality; and Glasgow Outcome Scale scores were compared among the 3 groups. RESULTS: Minimally invasive puncture and drainage was the least traumatic procedure and had the shortest operative time, but it could not remove the hematoma quickly; moreover, it had the highest rebleeding rate. Craniotomy was effective in removing the hematoma but resulted in marked trauma and had the highest incidence of pulmonary infection. Endoscopic surgery was safer and more effective than the other 2 surgical methods, with greater improvement in neurologic outcomes and no change in mortality. CONCLUSIONS: Minimally invasive neuroendoscopic management has the advantages of direct vision, efficient hematoma evacuation, and relatively good results. Endoscopic surgery may be a more promising approach for the treatment of moderate basal ganglia ICH.
OBJECTIVE: To date, no standard surgical procedure has been proven effective for intracerebral hemorrhage (ICH), particularly deep hematomas. This retrospective study evaluated the effectiveness and safety of endoscopic surgery, minimally invasive puncture and drainage, and craniotomy for treating moderate basal ganglia ICH. METHODS:Patients with basal ganglia ICH (N = 177) were divided into 3 groups based on therapeutic intervention as follows: endoscopic surgery group (n = 61), minimally invasive puncture and drainage group (n = 60), and craniotomy group (n = 56). Patient characteristics at admission were recorded. Operative time; blood loss during operation; evacuation rate; postoperative complications secondary to perihematomal edema, including rebleeding, infectious meningitis, pulmonary infection, gastrointestinal bleeding, and epilepsy; mortality; and Glasgow Outcome Scale scores were compared among the 3 groups. RESULTS: Minimally invasive puncture and drainage was the least traumatic procedure and had the shortest operative time, but it could not remove the hematoma quickly; moreover, it had the highest rebleeding rate. Craniotomy was effective in removing the hematoma but resulted in marked trauma and had the highest incidence of pulmonary infection. Endoscopic surgery was safer and more effective than the other 2 surgical methods, with greater improvement in neurologic outcomes and no change in mortality. CONCLUSIONS: Minimally invasive neuroendoscopic management has the advantages of direct vision, efficient hematoma evacuation, and relatively good results. Endoscopic surgery may be a more promising approach for the treatment of moderate basal ganglia ICH.