Surgical Interventions for Supratentorial Intracranial Hemorrhage: The Past, Present, and Future

Patel, Smruti; Saleh, Mohamed; Body, Alaina; Zuccarello, Mario

doi:10.1055/s-0040-1722639

Cited by 4 publications

(6 citation statements)

References 56 publications

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“…However, complications include surgical injury and the possibility of rebleeding after surgery, 7,16 and surgical outcomes in patients with severe acute HPH thus remain controversial. 3,17 Currently, the therapeutic strategy for deep-seated cerebral hemorrhages is a subject of continuous discourse, with the effectiveness of surgically removing hematomas primarily existing in the realm of theory. Within the context of neurotoxicity linked to cerebral hematomas, the scholarly community is divided between two prevailing theories.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Endoscopic Surgery Versus Craniotomy for Hypertensive Putamen Hemorrhage

Wang,

Sun,

Zhang

et al. 2024

Journal of Craniofacial Surgery

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Objective: This study aimed to evaluate the efficacy and safety of neuroendoscopy for treating hypertensive putamen hemorrhage (HPH), compared with traditional craniotomy. Methods: We retrospectively analyzed 81 consecutive patients with HPH treated with neuroendoscopy (n=36) or craniotomy (n=45) in the Department of Neurosurgery at the Anhui Provincial Hospital Affiliated to Anhui Medical University between January 2015 and December 2017. We compared the clinical and radiographic outcomes, excluded 14 patients who did not meet the inclusion criteria. Patient characteristics in emergency room were recorded. In addition, hospitalization days, total cost during hospitalization, operative time, blood loss, evacuation rate, rebreeding, intracranial infection, pulmonary infection, epilepsy, hemorrhage of digestive tract, venous thrombus, hypoproteinemia, aphasia, oculomotor paralysis, mortality, Modified Rankin Scale score 6 months after surgery, and Glasgow Outcome Scale score 6 months after surgery were compared between the 2 groups. Results: Comparative analysis of preoperative patient data revealed no notable disparities. Neuroendoscopic surgery afford distinct benefits including reduced operative time, minimal patient blood loss, and enhanced efficacy in hematoma evacuation. However, the incidence of postoperative complications such as rebleeding, intracranial infections, pulmonary infections, postoperative epilepsy, hemorrhage of digestive tract, venous thrombus, hypoproteinemia, aphasia, and oculomotor paralysis did not significantly differ. In contrast, endoscopic techniques, relative to conventional craniotomy for hematoma evacuation, are characterized by less invasive incisions, a marked decrease in the duration of hospitalization, and a substantial reduction in associated healthcare costs. Furthermore, endoscopic techniques contribute to superior long-term recuperative outcomes in patients, without altering mortality rates. Conclusions: In comparison to the conventional method of craniotomy, the utilization of neuroendoscopy in the treatment of hypertensive putamen hemorrhage (HPH) may offer a more efficacious, minimally invasive, and cost-effective approach. This alternative approach has the potential to decrease the length of hospital stays and improve long-term neurologic outcomes, without altering mortality rates.

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Endoscopic Surgery Versus Craniotomy for Hypertensive Putamen Hemorrhage

Wang,

Sun,

Zhang

et al. 2024

Journal of Craniofacial Surgery

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“…Treatment of primary cerebral hemorrhage is controversial. Previous studies have shown that neurosurgical treatment improves outcomes after cerebral hemorrhage better than conservative treatment [4][5] . Currently, the most commonly used surgical methods are neuroendoscopic hematoma removal, stereotactic burr hole drilling and drainage, and open craniotomy hematoma removal.…”

Section: Introductionmentioning

confidence: 99%

Multifactorial analysis of postoperative rebleeding in patients with spontaneous supratentorial intracerebral hemorrhage： a single-center experience

Song

Lei

Cai

et al. 2022

Preprint

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Spontaneous supratentorial intracerebral hemorrhage (SSICH) is an acute cerebrovascular disorder with high morbidity and mortality rates, Treatment of primary cerebral hemorrhage is controversial. However, postoperative rebleeding (or hematoma expansion) is a potential complication that can result in devastating progressive neurologic deterioration and high morbidity and mortality rates. It is also an inevitable and serious complication, which can result in progressive neurologic deterioration and death. The incidence of rebleeding 19.39% was found in our study and the results suggest that admission GCS score, irregular hematoma morphology on preoperative CT, poor postoperative blood pressure control, hematoma location, and surgical method were all risk factors of postoperative rebleeding. 3D Slicer-assisted neuroendoscopic surgery may be the most effective treatment for many patients with SSICH.

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“…Clinical typing can serve the treatment, and provide different treatment options to the families of patients [29]. On the one hand, the purpose of surgical treatment is to remove the hematoma, to reduce the primary injury and secondary injury caused by the hematoma to the brain stem, and on the other hand, to relieve the obstruction of the cerebrospinal fluid circulation system, and to reduce the excessive cranial pressure [20,27]. At present, the previous surgical schemes for brainstem haemorrhage include microscopic craniotomy and hematoma removal, stereotactic (ROSA robot) hematoma puncture and drainage, external ventricular drainage and other surgery [14].…”

Section: Introductionmentioning

confidence: 99%

Development and initial experience of a novel classification system for patients with brain stem haemorrhage

Li,

Wang,

Zhang

et al. 2023

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Introduction: There is no uniform classification standard for brain stem haemorrhage. On the basis of previous experience in the treatment of brainstem haemorrhage, this study explored and established a set of criteria for brainstem haemorrhage classification, risk-stratified such patients and guided the selection of treatment options so as to achieve accurate and standardized diagnosis and treatment. Material and methods: Thirty patients with brainstem haemorrhage from April 2019 to May 2022 were included. According to the amount and location of the brain stem bleeding, it was divided into the following types: small haemorrhage type (type 1), medium haemorrhage type (lateral type 2a, dorsal type 2b, ventral type 2c), and large haemorrhage type (type 3), and the preoperative condition and postoperative outcome within 3 months were evaluated. Results: The included 30 patients with brainstem haemorrhage were aged 53.2 ±13.8 years old, and 80% were men. Among them, 5 patients were type 1 (16.7%), 2 patients type 2a (6.7%), 7 patients type 2b (23.3%), 5 patients type 2c (16.7%) and 11 patients type 3 (36.7%). The prognosis among these subtypes was significantly different (p < 0.001). All type 1 patients were cured, with the highest mortality rate in type 2c patients (100%). Compared with type 2b (5.5 ±3.5 days) and type 2c (3.4 ±2.5 days), type 3 patients tended to have fewer days to die (2.9 ±2.7 days). The difference in NIHSS scores was significant among surviving patients (p < 0.001). Type 1 is the lowest at 1.8 ±2.2 points; type 3 is the highest at 35.0 ±3.5 points. Conclusions: Relying on the anatomical basis and treatment plan, we propose a different classification, which is conducive to quickly identifying the haemorrhage type and degree of disease, and putting forward an appropriate treatment plan, which is expected to improve the patient prognosis.

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Surgical Interventions for Supratentorial Intracranial Hemorrhage: The Past, Present, and Future

Cited by 4 publications

References 56 publications

Efficacy and Safety of Endoscopic Surgery Versus Craniotomy for Hypertensive Putamen Hemorrhage

Efficacy and Safety of Endoscopic Surgery Versus Craniotomy for Hypertensive Putamen Hemorrhage

Multifactorial analysis of postoperative rebleeding in patients with spontaneous supratentorial intracerebral hemorrhage： a single-center experience

Development and initial experience of a novel classification system for patients with brain stem haemorrhage

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