Endoscopic Surgery Without Decompressive Craniectomy in Large Putaminal Intracerebral Hemorrhage: Assessment of Efficacy and Safety

Ye, Yuanliang; Wang, Qiujing; Ou, Weiyang; Zhao, Zhihui

doi:10.1007/s12028-019-00880-8

Cited by 13 publications

(9 citation statements)

References 31 publications

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“…Patients were continuously enrolled at the interval between August 2018 and June 2020. The inclusion criteria were as follows: (1) supratentorial deep CCM including corona radiata, paraventricular, intraventricular, insula, basal ganglia, and thalamic; (2) patients had preoperative (1 week) and postoperative (3 months) DTI and treated by endoscopic surgery; (3) the distance between CCM and corticospinal tract (CST) was <1 cm on preoperative DTI images; (4) pathological diagnosis confirmed CCM; (5) follow-up at least 6 months; and (6) informed consent. The exclusion criteria were as follows:…”

Section: Methods Patientsmentioning

confidence: 99%

“…The inclusion criteria were as follows: ( 1 ) supratentorial deep CCM including corona radiata, paraventricular, intraventricular, insula, basal ganglia, and thalamic; ( 2 ) patients had preoperative (1 week) and postoperative (3 months) DTI and treated by endoscopic surgery; ( 3 ) the distance between CCM and corticospinal tract (CST) was <1 cm on preoperative DTI images; ( 4 ) pathological diagnosis confirmed CCM; ( 5 ) follow-up at least 6 months; and ( 6 ) informed consent. The exclusion criteria were as follows: ( 1 ) accompanied with other cerebral vascular malformations, except developmental venous abnormalities (DVA); ( 2 ) acute intracranial hemorrhage within 1 week; and ( 3 ) intracranial tumors or previous history of brain trauma and surgery. The study was approved by the Institutional Review Board of The First Affiliated Hospital of Fujian Medical University.…”

Section: Methodsmentioning

confidence: 99%

“…Accurate positioning and sparing adjacent eloquent fibers are the key points for the safe resection of deep CCMs. With the rapid advancement of imaging software and transparent tube sheath, endoscopic surgery has gradually become an effective and well-accepted method for treating deep intracranial hemorrhage (ICH) and supratentorial parenchymal tumors ( 3 , 4 ). However, its benefits have not been determined in deep CCM patients.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Surgery for Supratentorial Deep Cavernous Malformation Adjacent to Cortical Spinal Tract: Preliminary Experience and Technical Note

Lin

et al. 2021

Front. Neurol.

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In this study, we aimed to introduce a technical note and to explore the efficacy of endoscopic surgery combined with diffusion tensor imaging (DTI) navigation for supratentorial deep cerebral cavernous malformations (CCM). A prospectively maintained database of CCM patients was reviewed to identify all CCM patients treated by endoscopic surgery. The sagittal T1-weighted anatomical magnetic resonance imaging (MRI) and DTI were acquired before surgery. Endoscopic surgery was planned and performed based on preoperative DTI images and intraoperative DTI navigation. All patients were followed up more than 6 months. Motor function deficit and modified Rankin scale (mRS) scores were documented on follow-up. A final mRS score of 0–2 was considered a good outcome, and a final mRS score >2 was considered a poor outcome. Second DTI and 3DT1 were performed at 3 months after surgery. We tracked the ipsilateral corticospinal tract (CST) on pre- and postoperative DTI images. The overall mean FA values and the number of fibers of tracked CST were compared on pre- and postoperative DTI images. Risk factors associated with motor deficits and poor outcomes were analyzed. Seven patients with deep CCM and treated by endoscopic surgery were enrolled in this study. The mean value of preoperative mRS was 1.5 ± 0.98, but that score recovered to 0.86 ± 1.22 3 months later. The mRS scores were improved significantly according to statistical analysis (p = 0.012). According to the Spearman non-parametric test, only the fiber number of ipsilateral CST on postoperative DTI was significantly associated with muscle strength 6 months after surgery (p = 0.032). Compared with preoperative CST characteristics on DTI, the change of FA value (p = 0.289) and fiber number (p = 0.289) of ipsilateral CST on postoperative DTI was not significant It meant that the CST was protected during endoscopic surgery. Endoscopic surgery based on DTI navigation might be an effective method to protect fiber tracts in supratentorial deep CCM patients and improve long-term outcomes. However, more studies and cases are needed to confirm our findings.

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Section: Methods Patientsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Endoscopic Surgery for Supratentorial Deep Cavernous Malformation Adjacent to Cortical Spinal Tract: Preliminary Experience and Technical Note

Lin

et al. 2021

Front. Neurol.

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“…www.nature.com/scientificreports/ which require an immediate decrease of the intracranial pressure and for those with comorbidities that restricts the usage of general anesthesia. In fact, endoscopic surgery reportedly reduces complications compared to decompressive craniectomy surgery for putaminal hemorrhages of more than 50 mL 39 . Moreover, as a further possibility, endoscopy could also be used for patients that require immediate intracranial pressure reduction due to a hemorrhagic infarction 40 .…”

Section: Operative Time Reduction By Endoscopic Surgery Under Local Amentioning

confidence: 99%

Endoscopic hematoma removal of supratentorial intracerebral hemorrhage under local anesthesia reduces operative time compared to craniotomy

Katsuki

Kakizawa

Nishikawa

et al. 2020

Sci Rep

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The surgical efficacy for supratentorial intracerebral hemorrhage (ICH) remains unknown. We compared the advantages of the widely practiced endoscopic hematoma removal under local anesthesia with that of craniotomy under general anesthesia for ICH. We also focused on our novel operative concept of intentional hematoma leaving technique to avoid further damage to the brain. We retrospectively analyzed 134 consecutive patients (66 endoscopies and 68 craniotomies) who were surgically treated for supratentorial ICH. The characteristics of the 134 patients were as follows: The median (interquartile range) age was 73 (61-82) years. The median Glasgow Coma Scale scores at admission, on day 7, and the median modified Rankin Scale (mRS) score at 6 months were 10 (7-13), 13 (10-14), and 4 (3-5) respectively. The statistical comparison revealed there were no differences in GCS score on day seven between the endoscopy 13 (12-14) and craniotomy group 12 (9-14). No differences were observed in mRS scores at 6 months between the endoscopy 4 (2-5) and craniotomy group 4 (3-5). However, the patients treated with our technique tended to have favorable outcomes. Multivariate analysis revealed the operative time was significantly decreased in the endoscopy group compared to the craniotomy group (p < 0.001). Spontaneous intracerebral hemorrhages (ICHs) are responsible for 10%-30% of all strokes and they remain a significant cause of all stroke-related mortality and morbidity 1,2. ICH is a medical emergency with high fatality and disability rates. The median 30-day mortality rate after ICH is approximately 15-50% 3,4 and only 20% of patients regain functional independence within three months after the ictus 5. Surgical hematoma removal and conservative therapy are the main treatments for ICH; however, the role of surgery for most patients with ICH remains controversial. Theoretically, surgical hematoma removal prevents herniation by reducing the intracranial pressure and decreasing the pathophysiological impact of the hematoma on surrounding tissue 2. However, the effectiveness of surgery has been repeatedly evaluated 6,7 and its benefits are still under discussion. The Surgical Trial in Intracerebral Haemorrhage (STICH) indicated that patients with spontaneous supratentorial ICH showed no overall benefit from the early surgery when compared to the initial conservative therapy. However, operative intervention occurred in 24% of patients in the initial conservative treatment group 6. Therefore, the interpretation of these results is complicated. The STICH II trial confirmed that early surgery did not increase the rate of death or disability, 6 months postoperatively, and may have a small but clinically relevant survival advantage for patients with spontaneous superficial ICH without an intraventricular hemorrhage 7. A recent report based primarily on the STICH II trial reported that only patients with a GCS 10-13 or a large ICH were likely to benefit from surgery 8. However, the STICH and STICH II trials did not exhibit an overall comp...

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“…Unproven concepts about the value of decompressive craniectomy (DC) for intracerebral hemorrhage (ICH) may be arising from its use with large ischemic stroke [1,2]. Ye et al [3] present a retrospective study comparing endoscopic surgical removal of clot without decompression to DC with endoscopic clot evacuation in patients with large deep ICH. The authors conclude that endoscopic hematoma evacuation was safe and effective treatment for mass effect for those patients.…”

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confidence: 99%

Invited Editorial Commentary: More Than One Way to Treat the Mass Effect

Hanley

2019

Neurocrit Care

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Endoscopic Surgery Without Decompressive Craniectomy in Large Putaminal Intracerebral Hemorrhage: Assessment of Efficacy and Safety

Cited by 13 publications

References 31 publications

Endoscopic Surgery for Supratentorial Deep Cavernous Malformation Adjacent to Cortical Spinal Tract: Preliminary Experience and Technical Note

Endoscopic Surgery for Supratentorial Deep Cavernous Malformation Adjacent to Cortical Spinal Tract: Preliminary Experience and Technical Note

Endoscopic hematoma removal of supratentorial intracerebral hemorrhage under local anesthesia reduces operative time compared to craniotomy

Invited Editorial Commentary: More Than One Way to Treat the Mass Effect

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