The study objective is to analyze surgical outcomes in patients with hemorrhagic stroke treated by endoscopic aspiration in five regional vascular centers in Russia and to evaluate capabilities and benefits of this surgical procedure. Material and methods. The study included 296 patients with hemorrhagic stroke (with various locations of the hemorrhage) that underwent endoscopic aspiration between 2006 and 2018 at one of the following institutions: N.V. Sklifosovsky Research Institute for Emergency Medicine (Moscow), City Clinical Emergency Hospital No. 1 (Omsk), Regional Clinical Hospital (Yaroslavl), N.A. Semashko Republic Clinical Hospital (Simferopol), Irkutsk Regional Clinical Hospital. Neurosurgery departments of these healthcare institutions are the parts of regional vascular centers. We used Glasgow Outcome Scale to evaluate outcomes of surgical treatment. Results. Complete recovery was observed in 52 (17.5 %) patients, while 52 (17.5 %) patients developed moderate disability and 131 patients (44.5 %) developed severe disability. Four (1.5 %) patients developed a vegetative state. Fifty-seven (19 %) patients died after surgery. Conclusion. The experience of treating hemorrhagic stroke in five neurosurgical centers demonstrates that endoscopic aspiration of hypertensive intracerebral hemorrhages is in no way inferior to microsurgery. It ensures satisfactory results and can be used in patients with various hemorrhages.

AIM OF STUDY To compare the effectiveness of surgical treatment of patients with hypertensive intracerebral hematomas (ICHs) of subcortical location and methods of endoscopic aspiration and open removal.MATERIAl AND METHODS The results of surgical treatment of 97 patients with hypertensive subcortical hematomas were analyzed. In group 1 (n=52),endoscopic aspiration of the ICH was performed using a frameless  navigation station, in group 2 (n=45), open removal of the ICH was  performed using a microsurgical method.RESUlTS Mortality among patients in the age group over 71 years after endoscopic aspiration of ICH was significantly lower than after open removal (30.8% and 60%, respectively). With a decrease in the level of wakefulness to sopor, the mortality rate with endoscopic removal was 50%, and with open intervention — 66.7%, with a decrease to coma — 100% in both groups. Among patients of the 1st group with the volume of ICH less than 40 cm3, the lethality was 11.1%, while in the 2nd group this indicator was almost 2 times higher — 20%. With endoscopic removal of an intrauterine device with a volume of 40 to 60 cm3, the mortality rate reached 14.3%, and with an open removal of a hematoma of the same volume, this indicator reached 30%, while the mortality rate in both groups was similar with a volume of an intrauterine device from 61 to 100 cm3 and amounted to 23.1% and 21.4% in the 1st and 2nd groups, respectively. The radicality of hematoma removal in the 1st and 2nd groups was 86.4% and 86%, respectively.CONClUSION Endoscopic removal of hypertensive subcortical hematomas revealed a greater number of patients with good recovery, and postoperative mortality was 11.3% lower than with open removal, which, along with the  simplicity of execution and minimally invasiveness, indicates the safety and  efficiency of endoscopic aspiration for surgical treatment of patients with intracerebral hematomas of subcortical location.

The objectiveis to compare the effectiveness of surgical treatment of the patients with hypertensive intracerebral hematomas (ICH) using endoscopic aspiration and craniotomy removal.Materials and methods.Analysis of the results of surgical treatment of 132 patients with ICH. Patients of group I (n = 72) underwent craniotomy removal of ICH, group II (n = 60) underwent endoscopic intervention. Endoscopic ICH aspiration was performed using surgical navigation system and ventriculoscope (outer diameter – 6.5 mm, operating length – 13 cm, luminal area of the working channel – 20 mm2), with a high light-transmitting capacity.Results.Death rate in the patients over the age of 71 after endoscopic intervention was significantly lower than after craniotomy removal (45.4 and 86 %, respectively). In patients with soporose condition, death rate after open removal was 86.4 %, and after endoscopic aspiration – 44 %; in patients with wakefulness reduced to coma this indicator was 100 and 75 %, respectively. Death rate in the patients with thalamic ICH was 20 % after endoscopic intervention and 83.3 % after open surgery, with putaminal ICH – 39.5 and 50 %, respectively, with subcortical ICH – 22.7 and 0 %. Among patients with a hematoma with volume of up to 40 ml, death rate was 17.2 and 4.7 % in the groups I and II, respectively, with volume from 61 to 100 ml – 81.8 and 66.7 %.Conclusion. After endoscopy-guided removal of ICH the number of patients with good recovery increased 3-fold, and the post-operative mortality decreased by 19 %. The use of endoscopic technique in the treatment of hypertensive ICH under the control of neuronavigation (in comparison with open craniotomy removal and microsurgical ICH evacuation) improved the results of treatment due to decreasing of mortality rate and improvement of functional outcomes of the disease.