Endoscopic hematoma evacuation in patients with spontaneous supratentorial intracerebral hemorrhage

Wang, Wei‐Hsin; Hung, Yi-Chun; Hsu, Sanford P.C.; Lin, Chun‐Fu; Chen, Hsin‐Hung; Shih, Yang-Hsin; Lee, Cheng‐Chia

doi:10.1016/j.jcma.2014.08.013

Cited by 73 publications

(50 citation statements)

References 18 publications

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“…Surgical evacuation of the intracerebral hematoma can reduce the hematoma mass, decrease ICP, improve regional blood flow, and restrict the release of toxic breakdown products by blood clot. Endoscopic surgery has been gaining popularity as a method for surgical intervention in ICH patients [15][16][17]. During the surgery, a transparent tube was inserted into the hematoma center, hematoma was evacuated by suction through the working space, and as the sheath was gradually withdrawn, the residual hematoma was removed.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Surgery Without Decompressive Craniectomy in Large Putaminal Intracerebral Hemorrhage: Assessment of Efficacy and Safety

Wang

et al. 2019

Neurocrit Care

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Background: Decompressive craniectomy (DC) is performed conventionally for large putaminal intracerebral hemorrhage (ICH). However, DC causes local skull defect and leads to post-surgical cranioplasty. The aim of this study is to investigate the effectiveness and safety of an endoscopic procedure to treat large putaminal ICH without DC. Methods: This retrospective study included 112 large putaminal ICH patients who underwent hematoma evacuations with either an endoscopic procedure (group A) or with DC (group B) between January 2009 and June 2017. The efficacy was evaluated by mean modified Rankin Scale (mRS) three months after surgery. Safety was evaluated by mortality rate and postoperative complications. Univariate and multivariate logistic regression analyses were performed to determine the risk factors for clinical outcomes. Results: The study included 49 patients in group A and 63 in group B. The mRS scores in both groups were similar after 3 months' follow-up (p = 0.709). There was no difference in the mortality rate between the two groups (p = 0.538). The rate of complications was lower in group A than that in group B (p = 0.024). Smaller preoperative midline shift (p = 0.008) and absent intraventricular extension (p = 0.044) have contributed significantly to better outcomes. Conclusion: Endoscopic hematoma evacuation without DC is safe and effective for patients with large putaminal ICH and deserves further investigation, preferably in a randomized controlled setting.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Surgery Without Decompressive Craniectomy in Large Putaminal Intracerebral Hemorrhage: Assessment of Efficacy and Safety

Wang

et al. 2019

Neurocrit Care

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“…Endoscopic surgery has been applied for the treatment of HICH in recent years. Many studies suggested that endoscopic evacuation showed efficacy and safety benefit for HICH patients (Cho, Chen, Chang, Lee, & Tso, ; Nagasaka et al, ), when compared with traditional craniotomy (Wang et al, ; Yamashiro, Hitoshi, Yoshida, & Kuratsu, ). The result is in accordance with the latest systemic review (Xia et al, ).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of neuroendoscopic surgery versus craniotomy for supratentorial hypertensive intracerebral hemorrhage: A meta‐analysis of randomized controlled trials

et al. 2019

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BackgroundHypertensive cerebral hemorrhage (HCH) is a potentially life‐threatening neurological condition with an extremely high morbidity and mortality. In recent years, neuroendoscopy has been used to treat intracerebral hemorrhage (ICH). However, the choice of neuroendoscopic surgery versus craniotomy for patients with intracerebral hemorrhages is controversial.AimWe conducted this meta‐analysis to assess the efficacy of neuroendoscopic surgery compared with craniotomy in patients with supratentorial hypertensive ICH.MethodsA systematic electronic search was conducted of online electronic databases: PubMed, Embase, and the Cochrane Library updated on December 2017. The meta‐analysis only included randomized controlled studies.ResultsThree randomized controlled trials met our inclusion criteria. The pooled analysis of death showed that neuroendoscopic surgery decreased the rate of death when compared with craniotomy (RR = 0.58, 95% CI 0.26–1.29; p = .18). The pooled result of complications indicated that neuroendoscopic surgery has a tendency toward lower complications (RR = 0.37, 95% CI 0.28–0.49; p < .001).ConclusionsOur results suggested that neuroendoscopic surgery has lower complications, but no superior advantages in morbidity rates. Since the advantage of neuroendoscopic surgery has been performed in some area, the continuation of multi‐center comparative investigation with craniotomy may be necessary. Moreover, some efforts need to be taken in selecting appropriate patients with different treatments.

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“…In a 2015 study, neuroendoscopic surgery was successfully performed in local anesthesia, 31 making it safer and feasible for older adults with cardiopulmonary morbidities. Our study also showed that neuroendoscopic surgery exhibited similarly high hematoma ER and low rebleeding rate compared with craniotomy, and it could shorten the surgical time greatly and thus reduce perioperative morbidity.…”

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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Endoscopic hematoma evacuation in patients with spontaneous supratentorial intracerebral hemorrhage

Cited by 73 publications

References 18 publications

Endoscopic Surgery Without Decompressive Craniectomy in Large Putaminal Intracerebral Hemorrhage: Assessment of Efficacy and Safety

Endoscopic Surgery Without Decompressive Craniectomy in Large Putaminal Intracerebral Hemorrhage: Assessment of Efficacy and Safety

Efficacy of neuroendoscopic surgery versus craniotomy for supratentorial hypertensive intracerebral hemorrhage: A meta‐analysis of randomized controlled trials

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

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