Surgical Evacuation of Spontaneous Supratentorial Lobar Intracerebral Hemorrhage: Comparison of Safety and Efficacy of Stereotactic Aspiration, Endoscopic Surgery, and Craniotomy

Li, Yuqian; Yang, Ruixin; Li, Zhihong; Yang, Yanping; Tian, Bo; Zhang, Xingye; Bao, Wei; Lu, Dan; Guo, Shaochun; Man, Minghao; Yang, Yang; Luo, Tao; Gao, Guodong; Li, Lihong

doi:10.1016/j.wneu.2017.05.134

Cited by 58 publications

(49 citation statements)

References 32 publications

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“…32 Neuroendoscopic surgery reduces hospital costs 28 and provides a superior therapeutic effect in both short-term and long-term outcomes. 33 Given these merits, neuroendoscopic surgery might be safer and more effective and a promising approach for BGH. Although one study revealed that patients with life-threatening large brain hematoma treated with endoscopic surgery were rescued without decompressive craniectomy, even with cerebral herniation, 34 the decompression effect of endoscopic surgery was weaker than that of craniectomy.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Surgical Treatments for Basal Ganglia Hemorrhage and Imaging Factors Affecting Hematoma Evacuation Rate by Neuroendoscopic Surgery

Guo

Lin

Xie

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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Background Basal ganglia hemorrhage (BGH) is a devastating neurologic disease with high morbidity and mortality, and its management is still controversial. We evaluated the effectiveness of surgical treatments for BGH and investigated computed tomography (CT) imaging features affecting the hematoma evacuation rate (ER) in patients treated with neuroendoscopic surgery. Materials and Methods A total of 104 BGH patients who underwent craniotomy, burr-hole drainage, or neuroendoscopic surgery were analyzed retrospectively. Clinical characteristics, imaging features, and postoperative complications were compared. Univariate and multivariate regression analyses were applied to identify imaging factors associated with ER. Results A significant difference in ER was observed: 78.4% in patients treated with neuroendoscopic surgery, 33.6% in patients treated with burr-hole drainage, and 82.5% in patients treated with craniotomy (p < 0.001). Similar results were observed for operative time (p < 0.001). Five cases (12.5%) of rebleeding were found in patients treated with burr-hole drainage (p = 0.020). No significant difference was found for pneumonia, intracranial infection, gastrointestinal bleeding, hospital mortality, hospital stay, expenses, 3-day Glasgow Coma Scale (GCS) scores after surgery, or GCS at discharge. The CT imaging feature, the island sign (p = 0.004), was observed as an independent factor correlated with lower ER for neuroendoscopic surgery. Conclusions The benefits and drawbacks of surgical treatments confirmed they have their own indications, and neuroendoscopic surgery may be relatively beneficial for BGH treatment. The island sign was an independent factor affecting ER for neuroendoscopic surgery. Therefore, comprehensive assessment of clinical data, especially the island sign, should be performed preoperatively in BGH patients.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Surgical Treatments for Basal Ganglia Hemorrhage and Imaging Factors Affecting Hematoma Evacuation Rate by Neuroendoscopic Surgery

Guo

Lin

Xie

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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“…Further prospective studies are required to clarify which patients will benefit from an improved functional outcome by endoscopic hematoma removal. Apart from the meta-analyses, seven prospective and retrospective reports concluded that the chronic ADL scores improved following endoscopic hematoma removal compared to those following craniotomy [17][18][19][21][22][23]25 . However, these results were produced from selected patients, which does not fully reflect real clinical practice.…”

Section: Operative Time Reduction By Endoscopic Surgery Under Local Amentioning

confidence: 99%

“…However, the efficacy of endoscopic surgery compared to craniotomy remains unclear due to the small number of reports [17][18][19][20][21][22][23][24][25] and the heterogeneity of patients included in these studies. Only three meta-analyses (Table 1) have explored the effectiveness of the endoscopic procedures compared to craniotomy.…”

mentioning

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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“…While craniotomy was used as an appropriate treatment for ICH, its benefits were marginal at best. [ 44 ] Neuroendoscopy has been applied as an alternative treatment option for ICH in recent times, but its application remains controversial. [ 45 ] According to a meta-analysis by Yao et al .…”

Section: Intracranial Hemorrhagementioning

confidence: 99%

“…[ 43 ] While Li et al . report more effective hematoma clearance and better functional outcomes in the craniotomy group,[ 44 ] the literature has not reported any additional complications with neuroendoscopic treatment of ICH.…”

Section: Intracranial Hemorrhagementioning

confidence: 99%

A review of common endoscopic intracranial approaches

et al. 2020

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With the evolution of surgical techniques, endoscopy has emerged as a suitable alternative to many instances of more invasive methods. In this review article, we aim to discuss the endoscopic advancements, procedural details, indications, and outcomes of the most commonly practiced neuroendoscopic procedures. We have also summarized the uses, techniques, and challenges of neuroendoscopy in select neurosurgical pathologies.

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Surgical Evacuation of Spontaneous Supratentorial Lobar Intracerebral Hemorrhage: Comparison of Safety and Efficacy of Stereotactic Aspiration, Endoscopic Surgery, and Craniotomy

Cited by 58 publications

References 32 publications

Effectiveness of Surgical Treatments for Basal Ganglia Hemorrhage and Imaging Factors Affecting Hematoma Evacuation Rate by Neuroendoscopic Surgery

Effectiveness of Surgical Treatments for Basal Ganglia Hemorrhage and Imaging Factors Affecting Hematoma Evacuation Rate by Neuroendoscopic Surgery

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

A review of common endoscopic intracranial approaches

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