Endoscopic surgery for thalamic hemorrhage breaking into ventricles: Comparison of endoscopic surgery, minimally invasive hematoma puncture, and external ventricular drainage

Abstract

PurposeThalamic hemorrhage breaking into ventricles (THBIV) is a devastating disease with high morbidity and mortality rates. Endoscopic surgery (ES) may improve outcomes, although there is no consensus on its superiority. We investigated the efficacy and safety of ES and compared the outcomes of different management strategies by ES, hematoma puncture and drainage (HPD), and external ventricular drainage (EVD) in patients with THBIV.MethodsWe retrospectively analyzed patients with THBIV treated by ES, HPD, or EVD at our hospital from June 2015 to June 2018. Patients were categorized into anteromedial and posterolateral groups based on THBIV location, and then the two groups were further divided into ES, HPD, and EVD subgroups. Individualized surgical approach was adopted according to the location of the hematoma in the ES subgroups. Patient characteristics and surgical outcomes were investigated.ResultsWe analyzed 211 consecutive patients. There were no significant differences in clinical characteristics or incidence of perioperative procedure-related complications (postoperative rebleeding and intracranial infection) in either anteromedial or posterolateral groups. Compared with other therapeutic methods, the ES subgroups had the highest hematoma evacuation rate, shortest drainage time, and lowest incidence of chronic ventricular dilatation (all p < 0.05). Among the three anteromedial subgroups, ES subgroup had the best clinical outcomes which was assessed by the modified Rankin Scale, followed by HPD and EVD subgroups (p < 0.01); while in the posterolateral subgroups, clinical outcomes in the ES and HPD subgroups were similar and better than that in the EVD subgroup (p = 0.037).ConclusionIndividualized surgical ES approach for removal of thalamic and ventricular hematomas is a minimally invasive, safe, and effective strategy for the treatment of THBIV with a thalamic hematoma volume of 10–30 mL.

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

“…Previous reports have shown the efficacy of endoscopic surgery for thalamic hemorrhage, cerebellar hemorrhage, and IVH. [ 5 , 21 , 25 ] These results may imply that endoscopic surgery can be used for putaminal hemorrhages combined with thalamic or IVHs. This wide-ranging indication is an advantage of endoscopic surgery.…”

Neuroendoscopic Surgery versus Stereotactic Aspiration in the treatment of supratentorial intracerebral hemorrhage: a meta-analysis

“…In fact, several studies had been published and supported the use of NS for thalamic hemorrhage. 29,49,50 Fu et al analyzed the treatment of 211 patients with thalamic hemorrhage breaking into ventricles and found that endoscopy was more effective and safer in the treatment of thalamic hemorrhage, especially in the anteromedial group. 29 Some limitations still existed in our study.…”

“…29,49,50 Fu et al analyzed the treatment of 211 patients with thalamic hemorrhage breaking into ventricles and found that endoscopy was more effective and safer in the treatment of thalamic hemorrhage, especially in the anteromedial group. 29 Some limitations still existed in our study. Firstly, most of included studies were retrospective studies (only one RCT study).…”

“…The literature selection is presented in Figure 1, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 37 In the study of Fu et al, 29 they divided the subjects (patients with thalamic hemorrhage breaking into the ventricle) into Anteromedial group and Posterolateral group based on the location of hemorrhage. Therefore, we designed them into group A (Anteromedial group) and group B (Posterolateral group) for comparison in the same way.…”

Neuroendoscopic Surgery Versus Stereotactic Aspiration in the Treatment of Supratentorial Intracerebral Hemorrhage: A Meta-Analysis

“…F), most of them (n=63) were removed further due to these reasons: (1) had no controls; (2) contained subtentorial hemorrhage, inappropriate outcome indicators; (3) did not provide the full text. Finally, only 15 studies, 15,18,[24][25][26][27][28][29][30][31][32][33][34][35][36] including 2600 supratentorial ICH patients, met the inclusion criteria and were accepted in this meta-analysis. These studies included one RCT and fourteen OSs and the publication time ranged from 1998 to 2021.…”