Analysis of three surgical treatments for spontaneous supratentorial intracerebral hemorrhage

Abstract

This retrospective study aimed to evaluate the effectiveness and safety of 3 surgical procedures for Spontaneous Supratentorial Intracerebral Hemorrhage (SICH).A total of 63 patients with SICH were randomized into 3 groups. Group A (n = 21) underwent craniotomy surgery, group B (n = 22) underwent burr hole, urokinase infusion and catheter drainage, and group C (n = 20) underwent neuroendoscopic surgery. The hematoma evacuation rate of the operation was analyzed by 3D Slice software and the average surgery time, visualization during operation, decompressive effect, mortality, Glasgow Coma Scale (GCS) improvement, complications include rebleeding, pneumonia, intracranial infection were also compared among 3 groups.All procedures were successfully completed and the hematoma evacuation rate was significant differences among 3 groups which were 79.8%, 43.1%, 89.3% respectively (P < .01), and group C was the highest group. Group B was smallest traumatic one and shared the shortest operation time, but for the lack of hemostasis, it also the highest rebleeding group (P = .03). Although there were different in complications, but there was no significant in pneumonia, intracranial infection, GCS improvement and mortality rate.All these 3 methods had its own advantages and shortcomings, and every approach had its indications for SICH. Although for neuroendoscopic technical's minimal invasive, direct vision, effectively hematoma evacuation rate, and the relatively optimistic result, it might be a more promising approach for SICH.

Significance of endoscopic hematoma evacuation in elderly patients with spontaneous putaminal hemorrhage

“…Similar to previous findings, our current study showed that endoscopic surgery did not increase the frequency of postoperative bleeding compared to conventional open surgery. [ 1 , 15 ] Accurate comparison was not possible in this study since patients with hemorrhagic tendency were excluded from EN group. However, our results illustrate the benefit of hemostasis, as postoperative hemorrhage occurred in only 2.7% of the patients in the EN group, and all of the cases were asymptomatic.…”

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

“…Thus hematoma evacuation by early craniotomy can eliminate increased intracranial pressure, alleviate midline shift, improve cerebral blood flow surrounding the hematoma, and reduce the mortality rate. 23 Compared with burr-hole drainage and neuroendoscopic surgery, craniotomy is characterized by the more effective reduction of intracranial pressure 24 and low brain rebleeding rate after surgery. Owing to effective decompression, it is particularly suitable for patients with a large hematoma volume, enlarging BGH, or herniation.…”

Minimally Invasive Intracerebral Hemorrhage Evacuation Techniques: A Review

“…However, a similar study by Wang et al (2015) did not demonstrate comparably improved outcomes at the six month time point [ 55 ]. Likewise, Cai et al (2017) found no difference in functional or mortality outcomes for endoscopy in comparison to craniotomy or stereotactic aspiration, although endoscopy did have greater evacuation percentages [ 56 ]. Conversely, another study comparing these three methods found that endoscopy and stereotactic aspiration had greater functional outcomes than craniotomy.…”