Comparative study of neuroendoscopic minimally invasive surgery and craniotomy for supratentorial hypertensive cerebral hemorrhage / 中国脑血管病杂志

ABSTRACT

Objective: To investigate and compare the safety and efficacy of neuroendoscopic minimally invasive surgery and craniotomy for supratentorial hypertensive cerebral hemorrhage. Methods: From June 2016 to April 2018, 85 patients with hypertensive intracerebral hemorrhage treated in Department of Neurosurgery, the First Affiliated Hospital of University of South China were recruited. The time from onset to operation was 3-36 h, averaging 14 ± 7 h. All cases were supratentorial cerebral hemorrhage including 42 cases of basal ganglia cerebral hemorrhage, 28 cases of thalamic hemorrhage and 15 cases of cortical hemorrhage. 44 cases of hemorrhage were on the left side and 41 cases on the right side;38 cases of hemorrhage ruptured into ventricle. The blood loss ranged 32-82 ml, with an average of 52 ± 11 ml. Preoperative Glasgow coma scale(GCS) scores ranged from 6 to 12 points, with an average of 8. 2 ± 1. 5 points. According to different treatment methods, 85 patients were divided into two groups;the craniotomy group(n =51) and the endoscopic treatment group(n = 34). Baseline data, operation condition and related complications were recorded and compared between the two groups. The prognosis of the two groups was evaluated three months after the operation. The Glasgow prognostic scale score 4-5 was defined as favorable prognosis, and score 1-3 as unfavorable prognosis. Results: (1) There were no statistically significant differences in male gender, history of hypertension, age, preoperative GCS score, blood loss and bleeding site between the two groups(all P>0. 05). (2) The clearance rate of hematoma in the endoscopic treatment group was higher than that in the craniotomy group ([86. 7 ±2. 2] % vs. [70. 4 ±7. 2] %, t =9. 135), and the operation duration was shorter than that in the craniotomy group([72 ±6] mins vs. [149 ±21] mins, t = -20. 340). All the differences were statistically significant (all P 0.05). (3) The favorable prognosis rate in the endoscopic treatment group was higher than that in the craniotomy group with statistically significant difference (82. 4% [28/34] vs. 60. 8% [31/51] X2 =4.470, P=0.034). Conclusion: For the treatment of supratentorial spontaneous cerebral hemorrhage, hematoma removal by neuroendoscopic minimally invasive surgery is an alternative surgical method compared with craniotomy in terms of safety and efficacy.