Surgical Management of Moderate Basal Ganglia Intracerebral Hemorrhage: Comparison of Safety and Efficacy of Endoscopic Surgery, Minimally Invasive Puncture and Drainage, and Craniotomy

Fu, Chuhua; Wang, Ning; Chen, Bin; Wang, Pingli; Chen, Huayun; Liu, Wangwang; Liu, Lijun

doi:10.1016/j.wneu.2018.10.192

Cited by 47 publications

(28 citation statements)

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“…However, craniotomy prolongs the operation and anesthesia time, and increases the risk of infection and epilepsy. Moreover, craniotomy increases the risk of damage to the speech center and the vein of Labbe, leading to increased chance of complications [9,15]. Keyhole operation transsylvian-transinsular was performed in this study for moderate basal ganglion hematoma, and avoided the above defects of craniotomy.…”

Section: Discussionmentioning

confidence: 96%

Keyhole Evacuation for moderate basal ganglia Hematoma superior than Craniotomy

Peng

Zhu²,

Lan³

et al. 2020

Preprint

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Background: Spontaneous intracerebral hemorrhage (SICH) is the most devastate kind of stokes.For basal ganglia hematoma with volume ranged from 30 to 60 ml, different surgical procedures have been recommended by different neurosurgeons.This study aimed to compare the clinical outcomes and hospitalization cost between keyhole surgery and craniotomy for basal ganglia intracerebral hemorrhage.Methods: A retrospective analysis was performed on clinical data of 63 cases of keyhole procedure and 56 cases of craniotomy procedure. Hematoma evacuation rate, infection rate, re-bleeding, operation time, hospitalization cost and outcome were recorded.Results: The evacuation rate was similar in keyhole group and craniotomy group (P>0.05), and infection rate was lower in keyhole group compared to craniotomy group (P<0.05). Mean operation time and hospitalization cost were less in keyhole group than in craniotomy group (P<0.05). Mortality rate between two groups showed no significant differences. The patients operated within 6h had better outcome than those operated between 6-24h (p<0.05).Conclusion: For patients with basal ganglia hematoma ranged from 30-60 ml, keyhole surgery is safe and feasible, and operation within 6 h can improve the prognosis of the patients.

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Section: Discussionmentioning

confidence: 96%

Keyhole Evacuation for moderate basal ganglia Hematoma superior than Craniotomy

Peng

Zhu²,

Lan³

et al. 2020

Preprint

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“…The study concluded that this technique could potentially improve independent survival of patients with small basal ganglia ICH in a safe manner. 19 Conversely, in a more recent retrospective study by Fu et al 20 comparing effectiveness and safety of endoscopic surgery, minimally invasive puncture with drainage, and craniotomy for the treatment of moderate basal ganglia ICH (between 30 and 60 mL), MIS puncture with drainage was not found to provide rapid hematoma evacuation and had high rebleeding rates. Craniotomy, while effective in hematoma removal, was highly traumatic and had the highest incidence of medical complications.…”

Section: Stereotactic Aspiration With Thrombolysismentioning

confidence: 97%

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

et al. 2021

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Spontaneous supratentorial intracranial hemorrhage is extremely disabling and is associated with high mortality. Primary treatment for patients with this disease process is maximal medical management with blood pressure control and correction of clotting disorders due to comorbid conditions or medications. Over the past decade, significant strides have been made in understanding the benefits of surgical intervention in the treatment of intracranial hemorrhage through multiple clinical trials. In this article, we review the evolution of surgical treatments beginning with the STICH trials, discuss new developments with minimally invasive surgical strategies, and provide a brief update regarding ongoing trials and future directions in the treatment of spontaneous supratentorial intracranial hemorrhage.

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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, these results were produced from selected patients, which does not fully reflect real clinical practice. For example, many studies excluded cases with comorbidities 19,20 or severe neurological conditions, including patients with very low GCS scores 17,21,22,24 , patients using antithrombotic drugs 17,18 , and patients with massive hematomas (over 60 mL) 18,22 . Further, they included patients who did not represent clear surgical indications according to the Japanese Guidelines for the Management of Stroke 2015 29 nor 2009 30 , such as a hematoma volume between 20 and 30 mL 17,23,24 .…”

Section: Operative Time Reduction By Endoscopic Surgery Under Local Amentioning

confidence: 99%

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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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Surgical Management of Moderate Basal Ganglia Intracerebral Hemorrhage: Comparison of Safety and Efficacy of Endoscopic Surgery, Minimally Invasive Puncture and Drainage, and Craniotomy

Cited by 47 publications

References 28 publications

Keyhole Evacuation for moderate basal ganglia Hematoma superior than Craniotomy

Keyhole Evacuation for moderate basal ganglia Hematoma superior than Craniotomy

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

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

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