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

Abstract

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.

Rotitome-G: Principles and design concept of experimental compliant continuum robotic microsurgical endoscopic sarcotome for pixel/voxel-level target access neurosurgery

“…Otherwise, the solo application of a surgical microscope was and is still the best aid to maximize the excision of intracranial tumours. However, the microscopic view is limited to direct co-axial vision and poor illumination due to a divergent light beam from the overhead operating room light source (Du et al, 2022). The deeper the dissection lesser is the illumination of a tumour workpiece to both aided and unaided eyes of a surgeon.…”

“…Undoubtedly, the better illumination and wider view of hard-to-access sites with an endoscope are resulting in near complete resection of tumour tissue (Singh et al, 2018;Tammam et al, 2022). In the last decade, there have been several studies, including systematic reviews and meta-analyses, which have shown extremely favourable outcomes where a neuro-endoscope has been combined with a microscope (Du et al, 2022;Sayehmiri et al, 2022;Tan et al, 2022). It has helped not only to increase the volume of removed tumour tissue but also reduced operative time, intra-operative complications and post-surgical neurological deficits, and tumour recurrence (Barber et al, 2013;Rigante et al, 2019;Singh et al, 2018;Tammam et al, 2022).…”