Minimally Invasive Neurosurgery for Spontaneous Intracerebral Hemorrhage—10 Years of Working Progress at National Taiwan University Hospital

Abstract

Intracerebral hemorrhage (ICH) is a life-threatening disease with a global health burden. Traditional craniotomy has neither improved functional outcomes nor reduced mortality. Minimally invasive neurosurgery (MIN) holds promise for reducing mortality and improving functional outcomes. To evaluate the feasibility of MIN for ICH, a retrospective analysis of patients with ICH undergoing endoscopic-assisted evacuation was performed. From 2012 to 2018, a total of 391 patients who underwent ICH evacuation and 76 patients who received early (<8 h) MIN were included. The rebleeding, mortality, and morbidity rates were 3.9, 7.9, and 3.9%, respectively, 1 month after surgery. At 6 months, the median [interquartile range (IQR)] Glasgow Coma Scale score was 12 (4.75) [preoperative: 10 (4)], the median (IQR) Extended Glasgow Outcome Scale score was 3 (1), and the median (IQR) Modified Rankin Scale score was 4 (1). The results suggested that early (<8 h) endoscope-assisted ICH evacuation is safe and effective for selected patients with ICH. The rebleeding, morbidity, and mortality rates of MIN in this study are lower than those of traditional craniotomy reported in previous studies. However, the management of intraoperative bleeding and hard clots is critical for performing endoscopic evacuation. With this retrospective analysis of MIN cases, we hope to promote the specialization of ICH surgery in the field of MIN.

Stroke in Asia

“…In China, common interventional procedures for patients with ICH were the evacuation of ICH (9.3%) and burr-hole drainage of ventricle/burr-hole decompression of skull (4.1%) as reported by the China Hospital Quality Monitoring System [ 32 ]. In other parts of Asia, minimally invasive techniques have been widely used [ 33 , 34 ] and this technique appears promising with recent improvements [ 4 , 35 , 36 ]. A recent clinical trial conducted predominantly in Asia improved the outcome of patients with spontaneous ICH using a combined bundle of interventions including early blood pressure control and protocols for hyperglycaemia, fever, and rapid reversal of anticoagulation [ 5 ].…”

Safety and technical efficacy of early minimally invasive endoscopy-guided surgery for intracerebral haemorrhage: the Dutch Intracerebral haemorrhage Surgery Trial pilot study

“…NIHSS score (on admission), median (IQR) (13)(14)(15)(16)(17)(18)(19)(20)(21)(22) Systolic blood pressure, mmHg (on admission), mean (SD) (31) Diastolic blood pressure, mmHg (on admission), mean (SD)…”

“…Besides evacuation by means of a craniotomy, several minimally invasive techniques are available to remove the hematoma [2,17,36,41,55]. Recent case series suggest that endoscopy-guided minimally invasive evacuation by means of aspiration is promising and safe and effectively reduces haemorrhage volume, with few complications [1,11,19,23,27,41,45,46,53]. The MISTIE III trial recently failed to demonstrate a beneficial effect on functional outcome of minimally invasive surgery with local application of alteplase followed by hematoma aspiration up to 72 h [16].…”