Minimally Invasive Surgery for Spontaneous Supratentorial Intracerebral Hemorrhage

Abstract

Background and Purpose— There has been a nonstandard surgical procedure and extensive international controversy in minimally invasive surgery (MIS) for the management of spontaneous supratentorial intracerebral hemorrhage. This meta-analysis assessed the effectiveness of MIS as compared with other treatment options, including conservative medical treatment and conventional craniotomy, in patients with supratentorial intracerebral hemorrhage. Methods— PubMed, Embase, Cochrane Controlled Trials Register (CCTR), Web of Science, European Association for Grey Literature Exploitation (EAGLE), National Technical Information Service (NTIS), Current Controlled Trials, Clinical Trials, International Clinical Trials Registry, Internet Stroke Center, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI) (last searched December 2011) were searched. Randomized controlled trials on MIS in patients with computed tomography-confirmed supratentorial intracerebral hemorrhage were included. We excluded low-quality randomized controlled trials. The death or dependence at the end of follow-up was defined as the primary outcome, and the death at the end of follow-up was defined as the secondary outcome. Results— The 313 randomized controlled trials met the included criteria. We only analyzed 12 high-quality randomized controlled trials involving 1955 patients. The quality of the included trials was consistently high. OR of the primary outcome and secondary outcome of MIS both showed significant reductions (OR, 0.54, P <0.00001; OR, 0.53, P <0.00001). Conclusions— Patients with supratentorial intracerebral hemorrhage may benefit more from MIS than other treatment options. The most likely candidates to benefit from MIS are both sexes, age of 30 to 80 years with superficial hematoma, Glasgow Coma Scale score of ≥9, hematoma volume between 25 and 40mL, and within 72 hours after onset of symptoms. Our study could help select appropriate patients for MIS and guide clinicians to optimize treatment strategies in supratentorial intracerebral hemorrhage.

Minimally Invasive Surgery for Intracerebral and Intraventricular Hemorrhage

“…19 These authors reported a highly significant reduction in the end points of both death and dependence and death alone at the end of study follow-up. They determined that ICH patients with smaller hemorrhages (25-40 cm 3 ) and good presenting clinical status (Glasgow Coma Scale ≥9) were the most likely to benefit from MIS.…”

“…Although MIS for ICH is a routine clinical procedure in the Far East, with over 150 000 cases being performed per year, it is much less common in North America and Europe. 19 The current American Heart Association guidelines provide a Class IIb, Level of evidence B recommendation for the minimally invasive surgical treatment of ICH. …”

Mažos Trepanacijos (Minitrepanacijos) Metodika Šalinant Galvos Smegenų Hemoraginį Insultą. Klinikinis Atvejis Ir Metodikos Aprašymas

“…Tokiu atveju stebimas didžiausias šio gydymo metodo efektyvumas [22]. Tuo tarpu didesnę kraujosruvą dažniausiai siūloma šalinti atviruoju būdu, o mažesnes dažnai galima palikti ir konservatyviam gydymui.…”

“…Dėl šių priežasčių siūloma hematomos pašalinimą atlikti praėjus mažiausiai 6 val., bet ne daugiau nei 72 val. nuo simptomų pasireiškimo pradžios [22].…”

Minimally Invasive Surgery for Intracerebral Hematoma Evacuation followed by Rosiglitazone Infusion Therapy Increased Perihematomal Occludin, Zonula Occludens-1 Expression and Decreased the Blood Brain Barrier Permeability in Rabbits

“…MIS is a safe and practical technique in treating ICH. Patients with ICH may be benefit more from MIS than other treatment options [6][7][8][9]. Although MIS could effectively evacuate blood clot and reduce the brain damage following ICH, but does not completely remove the erythrocytes and cytotoxic substances which extravasate into the adjacent brain [10][11][12][13].…”