Surgical Management of Hypertensive Intracerebral Hemorrhage: a Comparison between Neuro-endoscopic and Craniotomic Hematoma Evacuation_West China Medical Journal

Authors：

 LeiBo , ZhangZhao ,  ZhengNiandong , WanXiaoqiang , WeiZhenghong , WenWei

Department of Neurosurgery, People's Hospital of Leshan, Leshan, Sichuan 614400, P. R. China;

Corresponding?author：

ZhengNiandong, Email: 278406847@qq.com

Keywords：

Neuro-endoscopy; Hypertension; Intracerebral hemorrhage of basal ganglia region

DOI：

10.7507/1002-0179.201600459

Video：

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Objective To explore and compare the therapeutic effects of neuro-endoscopic and craniotomic hematoma evacuation for hypertensive hematomas in the basal ganglia region. Methods Eighty-six patients with hypertensive hematomas in the basal ganglia regions treated between January 2010 and September 2014 were divided into neuro-endoscopy and craniotomy groups randomly with 43 in each. Hematoma was removed directly under neuro-endoscope in the endoscopic group, while it was removed under the operating microscope in the craniotomy group. The average operation bleeding amount, residual hematoma after operation, hematoma evacuation rate, the changes of National Institutes of Health Stroke Scale (NIHSS) and Barthel index (BI) scores before operation, 1 and 3 months after operation were compared between the two groups. All data were analyzed statistically. Results The average amount of operation bleeding was (127±26) mL, postoperative residual hematoma was (6±4) mL, and the hematoma clearance rate was (86±9)% in the neuro-endoscopy group, while those three numbers in the craniotomy group were respectively (184±41) mL, (11±6) mL, and (72±8)%, with all significant differences (P < 0.05). The NIHSS and BI scores were not significantly different between the two groups before surgery (P > 0.05). Seven days, one month and three months after surgery, the NIHSS score was significantly lower, and the BI score was significantly higher in the neuro-endoscopy group than the craniotomy group (P < 0.05). Conclusion Neuro-endoscopic surgery for hypertensive hematomas in basal ganglia region is proved to have such advantages as mini-invasion, direct-vision, complete clearance and good neural function recovery after surgery, which is a new approach in this field.

Citation： LeiBo, ZhangZhao, ZhengNiandong, WanXiaoqiang, WeiZhenghong, WenWei. Surgical Management of Hypertensive Intracerebral Hemorrhage: a Comparison between Neuro-endoscopic and Craniotomic Hematoma Evacuation. West China Medical Journal, 2016, 31(10): 1671-1674. doi: 10.7507/1002-0179.201600459 Copy

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2.	Pantazis G, Tsitsopoulos P, Mihas C, et al. Early surgical treatment vs conservative management for spontaneous supratentorial intracerebral hematomas: a prospective randomized study[J]. Surg Neurol, 2006, 66(5): 492-501; discussion 501-502.
3.	Anik I, Secer HI, Anik Y, et al. Meta-analyses of intracerebral hematoma treatment[J]. Turk Neurosurg, 2011, 21(1): 6-14.
4.	Wei GZ, Ji XM, Bai H, et al. Stroke research in China[J]. Neurol Res, 2006, 28(1): 11-15.
5.	陳波, 陳濤.顯微手術治療基底節區腦出血的臨床療效分析[J].中國社區醫師, 2015, 31(15): 25, 28.
6.	唐文元, 洪濤, 萬登敏.超早期顯微手術治療28例高血壓基底節區腦出血臨床療效分析[J].第三軍醫大學學報, 2014, 36(11): 1230-1231.
7.	Liu M, Wu B, Wang WZ, et al. Stroke in China: epidemiology, prevention, and management strategies[J]. Lancet Neurol, 2007, 6(5): 456-464.
8.	Anderson CS, Huang Y, Arima H, et al. Effects of early intensive blood pressure-lowing treatment on the growth of hematoma and perihematomal edema in acute intracerebral hemorrhage: the intensive blood pressure reduction in acute cerebral hemorrhage trial[J]. Stroke, 2010, 41(2): 307-312.
9.	Gregson BA, Broderick JP, Auer LM, et al. Individual patient data subgroup meta-analysis of surgery for spontaneous supratentorial intracerebral hemorrhage[J]. Stroke, 2012, 43(6): 1496-1504.
10.	徐亞東.基底節區腦出血微創手術方法療效分析[J].中外醫學研究, 2015(24): 100-101.
11.	陳長兵.神經內鏡在神經外科手術中的臨床應用[J].醫藥前沿, 2014(25): 140.
12.	Auer LM, Deinsberger W, Niederkorn K, et al. Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study[J]. J Neurosurg, 1989, 70(4): 530-535.
13.	Proust F. The treatment of spontaneous intracerebral haemorrhage: the value of craniotomy and new invasive procedures[J]. Sang Thromb Vaiss, 2008, 20(1): 19-24.
14.	Nakano T, Ohkuma H, Ebina K, et al. Neuroendoscopic surgery for intracerebral haemorrhage--comparison with traditional therapies[J]. Minim Invasive Neurosurg, 2003, 46(5): 278-283.
15.	Cho DY, Chen CC, Chang CS, et al. Endoscopic surgery for spontaneous basal ganglia hemorrhage: comparing endoscopic surgery, stereotactic aspiration, and craniotomy in noncomatose patients[J]. Surg Neurol, 2006, 65(6): 547-555.
16.	張亞卓, 王忠誠, 高鮮紅, 等.神經內窺鏡技術的臨床應用[J].中華神經外科雜志, 2000, 16(1): 3-7.
17.	Miller CM, Vespa P, Saver JL, et al. Image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage[J]. Surg Neurol, 2008, 69(5): 441-446.
18.	Nishihara T, Morita A, Teraoka A, et al. Endoscopy-guided removal of spontaneous intracerebral hemorrhage: comparison with computer tomography-guided stereotactic evacuation[J]. Childs Nerv Syst, 2007, 23(6): 677-683.

1. Towfighi A, Greenberg SM, Rosand J. Treatment and prevention of primary intracerebral hemorrhage[J]. Semin Neurol, 2005, 25(4): 445-452.
2. Pantazis G, Tsitsopoulos P, Mihas C, et al. Early surgical treatment vs conservative management for spontaneous supratentorial intracerebral hematomas: a prospective randomized study[J]. Surg Neurol, 2006, 66(5): 492-501; discussion 501-502.
3. Anik I, Secer HI, Anik Y, et al. Meta-analyses of intracerebral hematoma treatment[J]. Turk Neurosurg, 2011, 21(1): 6-14.
4. Wei GZ, Ji XM, Bai H, et al. Stroke research in China[J]. Neurol Res, 2006, 28(1): 11-15.
5. 陳波, 陳濤.顯微手術治療基底節區腦出血的臨床療效分析[J].中國社區醫師, 2015, 31(15): 25, 28.
6. 唐文元, 洪濤, 萬登敏.超早期顯微手術治療28例高血壓基底節區腦出血臨床療效分析[J].第三軍醫大學學報, 2014, 36(11): 1230-1231.
7. Liu M, Wu B, Wang WZ, et al. Stroke in China: epidemiology, prevention, and management strategies[J]. Lancet Neurol, 2007, 6(5): 456-464.
8. Anderson CS, Huang Y, Arima H, et al. Effects of early intensive blood pressure-lowing treatment on the growth of hematoma and perihematomal edema in acute intracerebral hemorrhage: the intensive blood pressure reduction in acute cerebral hemorrhage trial[J]. Stroke, 2010, 41(2): 307-312.
9. Gregson BA, Broderick JP, Auer LM, et al. Individual patient data subgroup meta-analysis of surgery for spontaneous supratentorial intracerebral hemorrhage[J]. Stroke, 2012, 43(6): 1496-1504.
10. 徐亞東.基底節區腦出血微創手術方法療效分析[J].中外醫學研究, 2015(24): 100-101.
11. 陳長兵.神經內鏡在神經外科手術中的臨床應用[J].醫藥前沿, 2014(25): 140.
12. Auer LM, Deinsberger W, Niederkorn K, et al. Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study[J]. J Neurosurg, 1989, 70(4): 530-535.
13. Proust F. The treatment of spontaneous intracerebral haemorrhage: the value of craniotomy and new invasive procedures[J]. Sang Thromb Vaiss, 2008, 20(1): 19-24.
14. Nakano T, Ohkuma H, Ebina K, et al. Neuroendoscopic surgery for intracerebral haemorrhage--comparison with traditional therapies[J]. Minim Invasive Neurosurg, 2003, 46(5): 278-283.
15. Cho DY, Chen CC, Chang CS, et al. Endoscopic surgery for spontaneous basal ganglia hemorrhage: comparing endoscopic surgery, stereotactic aspiration, and craniotomy in noncomatose patients[J]. Surg Neurol, 2006, 65(6): 547-555.
16. 張亞卓, 王忠誠, 高鮮紅, 等.神經內窺鏡技術的臨床應用[J].中華神經外科雜志, 2000, 16(1): 3-7.
17. Miller CM, Vespa P, Saver JL, et al. Image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage[J]. Surg Neurol, 2008, 69(5): 441-446.
18. Nishihara T, Morita A, Teraoka A, et al. Endoscopy-guided removal of spontaneous intracerebral hemorrhage: comparison with computer tomography-guided stereotactic evacuation[J]. Childs Nerv Syst, 2007, 23(6): 677-683.

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