Comparison and analysis of the efficacy and safety of minimally invasive surgery and craniotomy in the treatment of hypertensive intracerebral hemorrhage

Zhang, Jixin; Lu, Shiyong; Wang, Shuzhen; Zhou, Naiyun; Li, Guoliang

doi:10.12669/pjms.343.14625

Cited by 15 publications

(24 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The full text of the remaining 62 articles were retrieved, and 48 were excluded for the following reasons: (1) lack of control group ( n = 27); (2) meta-analysis ( n = 8); (3) review papers ( n = 4); (4) bleeding located in the cerebellum (3); (5) Clinical protocol models ( n = 2); (6) full texts not available ( n = 2);( 7) erratum ( n = 1); (8) letter to editors ( n = 1). Finally, 14 studies were included in the final analysis, comprising 4 RCTs [ 10 – 13 ] and 10 non-RCTs [ 14 – 23 ]) (Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Nine trials [ 10 – 13 , 16 , 19 , 21 – 23 ] (4 RCTs and 5 non-RCTs) evaluating 744 patients (378 and 366 patients in the experimental and control arms, respectively) assessed evacuation rates. There were significant differences in evacuation rate for the RCT and non-RCTs groups, with SMD = 1.08 (95%CI 0.31–1.86, P = 0.006) and SMD = 1.08 (95%CI 0.15–2.01, P = 0.007), respectively，indicating that the patients who administered NE had a higher evacuation rate than those who underwent craniotomy in the RCT and non-RCT group.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Endoscopic surgery versus craniotomy in the treatment of spontaneous intracerebral hematoma: a systematic review and meta-analysis

Lin

Wang

et al. 2022

Chin Neurosurg Jl

View full text Add to dashboard Cite

Background Spontaneous intracerebral hemorrhage (SICH) has high morbidity and mortality, with no clear standard of treatment available. Compared with the craniotomy approach, neuroendoscopy is a relatively minimally invasive treatment method, and may be an efficient alternative. Therefore, this meta-analysis aimed to assess the clinical efficacy of neuroendoscopy and craniotomy in SICH patients. Methods The electronic databases Web of Science, PubMed, EmBase, MEDLINE, and the Cochrane Library were systematically searched. According to the PRISMA template, we finally selected and analyzed 14 eligible studies that evaluated neuroendoscopy versus craniotomy. Primary outcomes included operation time, intraoperative blood loss volume, evacuation rate, residual hematoma, complications, hospital stay duration, clinical outcomes, and other parameters. Results A total of 4 randomized controlled trials (RCTs) and 10 retrospective studies (non-RCTs) involving 1652 patients were included in the final analysis. In the neuroendoscopy (NE) group, operation time (p < 0.00001), intraoperative blood loss volume (p < 0.0001), hematoma evacuation rate (p = 0.0002), complications (p < 0.00001), hospitalization days (p = 0.004), and mortality (p < 0.0001) were significantly different from those of the craniotomy (C) group, with a higher rate of good recovery compared with the craniotomy group (P < 0.00001). Conclusions These findings suggest that patients with SICH and physicians may benefit more from neuroendoscopic surgery than craniotomy.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Endoscopic surgery versus craniotomy in the treatment of spontaneous intracerebral hematoma: a systematic review and meta-analysis

Lin

Wang

et al. 2022

Chin Neurosurg Jl

View full text Add to dashboard Cite

show abstract

“…Currently, there are many surgical treatments for cerebral haemorrhage, most of which are empirical treatments developed within different medical centres, although no consensus has been reached to date 13 . Common surgical methods, such as trepanation and drainage, craniotomy evacuation of haematoma, and neuroendoscopic treatment for cerebral haemorrhage, have their own advantages and disadvantages and respective indications for adaptation 14 , 15 .…”

Section: Discussionmentioning

confidence: 99%

“…Craniotomy for removal of haematoma involves two types of operations: large trauma craniotomy and small bone window craniotomy. The large trauma craniotomy for haematoma removal has the advantages of a high haematoma clearance rate and less chance of rebleeding, but it has more limitations, such as a long operative time, serious intraoperative brain pulling, severe secondary brain injury, heavy trauma, and more intraoperative bleeding 13 . Although small bone window craniotomy for haematoma removal relatively shortens the operative time, it can still cause serious intraoperative brain pulling and severe secondary brain injury.…”

Section: Discussionmentioning

confidence: 99%

The rule of brain hematoma pressure gradient and its influence on hypertensive cerebral hemorrhage operation

Sun

Liu

et al. 2021

Sci Rep

View full text Add to dashboard Cite

To comparatively study the size of and variation in the ‘brain-haematoma’ pressure gradient for different surgical methods for hypertensive intracerebral haemorrhage (HICH) and analyse the gradient’s influence on surgical procedures and effects of the haemorrhage. Seventy-two patients with HICH treated from 1/2019 to 12/2019 were randomly divided into two groups, namely, the keyhole endoscopy and large trauma craniotomy groups, according to different operative methods. Intraoperative changes in intracranial pressure (ICP) were monitored to calculate intraoperative alterations in the ‘brain-haematoma’ pressure gradient. Intraoperative characteristics (operative time, bleeding volume, volume of blood transfusion, and haematoma clearance rate) and postoperative characteristics (oedema, postoperative activities of daily living (ADL) scores, mortality rate and rebleeding rate) were compared between the two groups. In the keyhole endoscopy group, ICP decreased slowly; the ‘brain-haematoma’ pressure gradient was large, averaging 251.1 ± 20.6 mmH2O, and slowly decreased. The mean operative time was 83.6 ± 4.3 min, the mean bleeding volume was 181.2 ± 13.6 ml, no blood transfusions were given, the average postoperative haematoma clearance rate was 95.6%, the rate of severe oedema was 10.9%, and the average postoperative ADL score was 85.2%. In the large trauma craniotomy group, ICP rapidly decreased after craniotomy. When the haematoma was removed, the ‘brain-haematoma’ pressure gradient was small, averaging 132.3 ± 10.5 mmH2O, and slowly decreased. The mean operative time was 232 ± 26.1 min, the mean bleeding volume was 412.6 ± 35.2 ml, the average volume of blood transfusion was 281.3 ± 13.6 ml, and the average postoperative haematoma clearance rate was 82.3%; moreover, the rate of severe oedema was 72.1%, and the average postoperative ADL score was 39.0%. These differences were statistically significant (P < 0.05). Neither the death rate (P > 0.05, 2.7% VS 2.8%) nor rebleeding rate (P > 0.05, 2.7% VS 2.8%) showed any obvious changes. The magnitude and variation in the ‘brain-haematoma’ pressure gradient for different surgical methods significantly influence surgical procedures and effects of HICH. During keyhole endoscopy surgery, this gradient was relatively large and slowly decreased; the haematoma was therefore easier to remove. Advantages of this approach include a high haematoma clearance rate, decreased bleeding volume, decreased operative time, reduced trauma, decreased postoperative brain oedema and improved postoperative recovery of neurological function.Chinese Clinical Trial Register: ChiCTR1900020655 registration in 12/01/02,019 registration in 28/02/02,020 Number: NCOMMS-20–08,091.

show abstract

“…Meanwhile, 40% of survivors are severely disabled, and only 12% of them can live independently, having a huge impact on families and society ( 5 , 6 ). Surgery is the most common treatment of ICH, and it has been greatly improved with the accumulation of surgical experience and progress in scientific research ( 7 ). However, there are different surgical procedures with varying prognoses ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

Experience of Using a New Brain Surgery Head Frame and Location Sticker for Treating Spontaneous Intracranial Hematoma

Wang

Xin

2022

Front. Neurol.

View full text Add to dashboard Cite

ObjectivesVarious stereotactic aspirations have been accepted; however, no standard stereotactic aspiration has been established for the treatment of spontaneous intracerebral hemorrhage (ICH). The authors explored an easy, fast, and effective procedure by using a new brain surgery head frame and location sticker for the removal of spontaneous hematoma.Patients and MethodsA retrospective database review was performed from January 2018 to March 2020 to identify patients with ICH who were treated with puncture and drainage for hematoma by using a new brain surgery head frame and location sticker for positioning and guidance.ResultsA total of 45 patients with spontaneous ICH were enrolled in our study. The mean (± SD) surgical time was 29.3 ± 4.1 min. The average hematoma evacuation rate was 72.2%. The mean (± SD) preoperative Glasgow Coma Scale (GCS) score was 9.58 ± 2.92; the mean GCS score increased to 11.55 ± 2.59 (p = 0.006) and 12.86 ± 2.04 (p < 0.001) at 1 week after surgery and at the time of discharge, respectively. The mean (± SD) preoperative muscle force score was 1.25 ± 1.51; the mean muscle force score had improved to 2.20 ± 1.64 (p = 0.009) and 2.88 ± 1.64 (p < 0.001) at 1 week after the operation and the time of discharge, respectively. Out of these, one patient experienced postoperative rebleeding, however, no further hematoma expansion was found after the second aspiration and thrombolysis.ConclusionUsing this brain surgery, head frame and location sticker combined with urokinase infusion appears simple, safe, and effective for the removal of hematoma for patients with spontaneous ICH. However, randomized controlled trials are necessary to provide more concrete evidence-based results.

show abstract

Comparison and analysis of the efficacy and safety of minimally invasive surgery and craniotomy in the treatment of hypertensive intracerebral hemorrhage

Cited by 15 publications

References 12 publications

Endoscopic surgery versus craniotomy in the treatment of spontaneous intracerebral hematoma: a systematic review and meta-analysis

Endoscopic surgery versus craniotomy in the treatment of spontaneous intracerebral hematoma: a systematic review and meta-analysis

The rule of brain hematoma pressure gradient and its influence on hypertensive cerebral hemorrhage operation

Experience of Using a New Brain Surgery Head Frame and Location Sticker for Treating Spontaneous Intracranial Hematoma

Contact Info

Product

Resources

About