A Meta-analysis for Evaluating Efficacy of Neuroendoscopic Surgery versus Craniotomy for Supratentorial Hypertensive Intracerebral Hemorrhage

OBJECTIVE: Hypertensive intracerebral hemorrhage is a potentially life-threatening neurological deficit with the highest morbidity and mortality. In recent years, neuroendoscopy has been used to treat intracerebral hemorrhages (ICHs). However, the choice of neuroendoscopic surgery or craniotomy for patients with ICHs is controversial. The objective of this meta-analysis was to assess the efficacy of neuroendoscopic surgery compared to craniotomy in patients with supratentorial hypertensive ICH.MATERIALS AND METHODS: A systematic electronic search was performed using online electronic databases such as Pubmed, Embase, and Cochrane library updated on December 2017. The meta-analysis was performed by only including studies designed as randomized controlled trials.RESULTS: Three randomized controlled trials met our inclusion criteria. Pooled analysis of death showed that neuroendoscopic surgery decreased the rate of death compared to craniotomy (RR=0.58, 95% CI: 0.26–1.29; P=0.18). Pooled results of complications showed that neuroendoscopic surgery tended to have fewer complications than craniotomy had (RR=0.37, 95% CI: 0.28–0.49; P < 0.0001).CONCLUSION: Although the presenting analyses suggest that neuroendoscopic surgery should have fewer complications than craniotomy dose, it had no superior advantage in morbidity rate definitely. Therefore, it may be necessary for the neurosurgeons to select best optimal patients for individual treatment.

Neuroendoscopic hematoma evacuation in patients with hypertensive cerebellar hemorrhage / 中国神经精神疾病杂志

Objective The aim of our study was to examine the clinical value of neuroendoscopic surgery in hypertensive cerebellar hemorrhage.Methods The clinical data from 38 patients with cerebellar hemorrhage were retrospectively analyzed.Thirty-eight patients included 18 cases with neuroendoscopic hematoma evacuation (neuroendoscopic group) and 20 cases with craniotomy hematoma evacuation (craniotomy group).The perioperative parameters and clinical outcome were statistically analyzed.Results Compared with craniotomy group,the mean operative time was shorter [(82.9±17.0)min vs.(177.9±28.8)min,t=12.545,P=0.000],the loss of mean blood volume was smaller [(45.1±15.6)mL vs.(197.9±29.5)mL,t=20.237,P=0.000]ml,ventricle drainage time [(3.5±1.5)d vs.(5.3±1.4)d,t=3.751,P=0.001],ICU stay time [(2.9±1.0)d vs.(4.7±1.5)d,t=4.146,P=0.000] and hospital stay time [(7.4±1.5)d vs.(9.9±2.8)d,t=3.348,P=0.002] were shorter (P＜0.05).Two weeks after surgery,1 cases died in neuroendoscopic group and 2 cases died in craniotomy group (P=1.000,P＞0.05).Three months after surgery,GOSE was greater than 4 in 14 cases in neuroendoscopic group and in 13 cases in craniotomy group and the difference was not significant (2=0.752,P=0.386,P＞0.05).Conclusion Although there are no differences in mortality and clinical outcomes between neuroendoscopic hematoma evacuation and occipital craniotomy hematoma evacuation for hypertensive cerebellar hemorrhage patients,neuroendoscopic hematoma evacuation can significantly reduce the mean operative time,the loss of mean blood volume,ventricle drainage time,ICU stay time and hospital stay time.Thus,neuroendoscopic hematoma evacuation in hypertensive cerebellar hemorrhage is safe and effective,which has a great value of application in the future.

Neuroendoscopic hematoma evacuation in patients with hypertensive cerebellar hemorrhage / 中国神经精神疾病杂志

Objective The aim of our study was to examine the clinical value of neuroendoscopic surgery in hypertensive cerebellar hemorrhage.Methods The clinical data from 38 patients with cerebellar hemorrhage were retrospectively analyzed.Thirty-eight patients included 18 cases with neuroendoscopic hematoma evacuation (neuroendoscopic group) and 20 cases with craniotomy hematoma evacuation (craniotomy group).The perioperative parameters and clinical outcome were statistically analyzed.Results Compared with craniotomy group,the mean operative time was shorter [(82.9±17.0)min vs.(177.9±28.8)min,t=12.545,P=0.000],the loss of mean blood volume was smaller [(45.1±15.6)mL vs.(197.9±29.5)mL,t=20.237,P=0.000]ml,ventricle drainage time [(3.5±1.5)d vs.(5.3±1.4)d,t=3.751,P=0.001],ICU stay time [(2.9±1.0)d vs.(4.7±1.5)d,t=4.146,P=0.000] and hospital stay time [(7.4±1.5)d vs.(9.9±2.8)d,t=3.348,P=0.002] were shorter (P＜0.05).Two weeks after surgery,1 cases died in neuroendoscopic group and 2 cases died in craniotomy group (P=1.000,P＞0.05).Three months after surgery,GOSE was greater than 4 in 14 cases in neuroendoscopic group and in 13 cases in craniotomy group and the difference was not significant (2=0.752,P=0.386,P＞0.05).Conclusion Although there are no differences in mortality and clinical outcomes between neuroendoscopic hematoma evacuation and occipital craniotomy hematoma evacuation for hypertensive cerebellar hemorrhage patients,neuroendoscopic hematoma evacuation can significantly reduce the mean operative time,the loss of mean blood volume,ventricle drainage time,ICU stay time and hospital stay time.Thus,neuroendoscopic hematoma evacuation in hypertensive cerebellar hemorrhage is safe and effective,which has a great value of application in the future.

Endoscopic Aqueductoplasty and Stenting for Isolated Fourth Ventricle

Isolated fourth ventricle(IFV) is a rare entity producing symptoms of a progressive posterior fossa mass lesion. It is mainly reported in a patient who undergo shunt placement as its late complication. However, its surgical management has been difficult and its optional treatment remains controversial. We had an occasion to admit 19-year-old female to our hospital due to hydrocephalus: she had a history of meningitis when she was 2 years old. Ten years later, she was diagnosed as hydrocephalus and managed by lateral ventriculo-peritoneal shunting procedure. Seven years after the procedure, the patient presented with headache, nausea, truncal ataxia and nystagmus. Computed tomography and magnetic resonance image scan demonstrated markedly enlarged fourth ventricle: and thus, neuroendoscopic aqueductoplasty and aqueductal stent insertion was performed. The authors present a case of an IFV after lateral ventriculo-peritoneal shunting for hydrocephalus, which was treated successfully with a neuroendoscopic surgery. The technique of this procedure is described below.

Development of a Cyber Medical Training System by using Internet MPEG Technology / 대한의료정보학회지

The purpose of the present study is to develop a CRM system for patients with diabetes mellitus. The subjects were outpatients who visited a university hospital from March, 1997 thru February, 2003. The distributions of outpatients, types of disease, revenues, exemption of designated doctor's fee, and no-show rate were obtained for each department by utilizing the OCS database. Quantitative and Qualitative data were collected from the diabetes patients chosen based on the distribution. The goals of applying the CRM are not to provide diabetes patients with general medical services, but to provide individually-tailored medical services by utilizing the information obtained from the departments of moment of truth(MOT) effectively and integrating the management of work process and human resources. For an effective application of the CRM, it needs to be performed to support the strategic objectives and incorporate management strategies that are appropriate for internal and external environments. That modeling for diabetes patients includes campaign activities, customer management process, and the functions of predicting and diagnosing the patients and managing the medical services of MOT departments and referral system.

Endoscopic Multiple Wide Fenestrations of Intraventricular Arachnoid Cyst Arising in Lateral Ventricle

Intraventricular arachnoid cyst is an uncommon disease and a few surgical experiences have been reported. The authors present an experience of neuroendoscopic surgery in a 4-year-old-male patient with a large arachnoid cyst arising from the right lateral ventricle, who had suffered from generalized tonic clonic seizure. On operation, various portions of the cyst could be easily approached without unwanted parenchymal injury because most of the cystic membrane was movable and not adherent to the ventricular wall except choroid plexus area, which could be considered as origin site of the cyst. Marked shrinkages by electrocoagulation and multiple wide fenestrations of the cyst were obtained through the endoscopic working channel without difficulty. Postoperative brain computed tomography demonstrated decreasing ventricular size with no evidence of cystic recurrence. The postoperative course was uneventful for eight months follow-up period. We suggest that endoscopic procedure has definite advantages as the surgical method of choice for the treatment of intraventricular arachnoid cysts.