Comparison of endoscopic evacuation, stereotactic aspiration, and craniotomy for treatment of basal ganglia hemorrhage

Abstract

BackgroundThe main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques.ObjectiveTo explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage.MethodsFive hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes.ResultsFor the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40–<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551).ConclusionEndoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.

Long-Term Effect of Endoscopic Evacuation for Large Basal Ganglia Hemorrhage With GCS Scores ≦ 8

“…Only 24.65 and 20% of patients have an initiate GCS score ≤ 8 in the STICH study and MISTIE study. Whereas, 59% of patients have an initiate GCS score ≤ 8 in our center (23).…”

“…Besides, our previous study compared the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage. According to the subgroup analysis stratified by hematoma volume, endoscopic aspiration can decrease the 6-months mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥ 40 ml ( 23 ). Thus, the present study explored the long-term outcomes of endoscopic evacuation, stereotactic aspiration, and craniotomy in the treatment of large basal ganglia hematoma patients (≥40 ml) with initial GCS ≤ 8.…”

Comparison of Long-Term Outcomes of Endoscopic and Minimally Invasive Catheter Evacuation for the Treatment of Spontaneous Cerebellar Hemorrhage

“…We previously reported that compared with MIC evacuation, endoscopic evacuation could significantly decrease 6-month mortality in patients with basal ganglia hemorrhage [ 20 ]. However, among the surviving patients, only 22.4% achieved a good neurological recovery (mRS score ≤ 2) at 6 months.…”

Stereotactic computed tomography-guided aspiration of intracerebral hemorrhage using the Cosman-Roberts-Wells system

“…Besides STICH trials, there are many reported RCTs including the National Institutes of Health spon-sored Minimally Invasive Surgery Plus recombinant tissue plasminogen activator (rt-PA) for ICH Evacuation (MISTIE) trial evaluating stereotactic thrombolysis, the endoscopic arm of MISTIE referred to as the Intraoperative Stereotactic Computed Tomography-Guided Endoscopic Surgery trial, the Early Minimally-Invasive Removal of Intracerebral Hemorrhage trial and the Minimally Invasive Endoscopic Surgical Treatment With Apollo/ Artemis in Patients With Brain Hemorrhage [14]. Although most recently reported MISTIE III trial concluded that MISTIE did not improve the proportion of patients who achieved a good response 365 days after ICH [15], many other studies including meta-analysis reported that the minimally invasive procedures especially for endoscopic evacuation, seem to be more effective than conservative treatment in reducing both morbidity and mortality [16][17][18][19][20].…”