Elsevier

World Neurosurgery

Volume 105, September 2017, Pages 332-340
World Neurosurgery

Original Article
Surgical Evacuation of Spontaneous Supratentorial Lobar Intracerebral Hemorrhage: Comparison of Safety and Efficacy of Stereotactic Aspiration, Endoscopic Surgery, and Craniotomy

https://doi.org/10.1016/j.wneu.2017.05.134Get rights and content

Background

The safety and efficacy of craniotomy, endoscopic surgery, and stereotactic aspiration for surgical evacuation of spontaneous supratentorial lobar intracerebral hemorrhage (ICH) is yet uncertain. The present study analyzed the clinical and radiographic data from 99 patients with spontaneous supratentorial lobar ICH, retrospectively, to address this issue.

Methods

Patients who underwent craniotomy, endoscopy surgery, or stereotactic aspiration were assigned to the craniotomy group (n = 31), endoscopy surgery group (n = 32), or stereotactic aspiration group (n = 36), respectively. The characteristics of all the enrolled patients at the time of admission were assimilated. Also, the therapeutic effects of the three surgical procedures were evaluated based on short-term outcomes within 30 days and long-term outcomes at 6 months after the ictus.

Results

The results showed that stereotactic aspiration and endoscopic surgery were associated with a superior clinical therapeutic effect in both short-term and long-term outcomes than craniotomy for the treatment of spontaneous supratentorial lobar ICH. Notably, severely affected patients with hematoma volume > 60 mL or Glasgow Coma Scale score 4–8 may benefit more from endoscopic surgery than the two other surgical procedures.

Conclusions

The current findings demonstrate that both stereotactic aspiration and endoscopic surgery possess an apparent advantage over craniotomy for the evacuation of spontaneous supratentorial lobar ICH. The endoscopic surgery might be more safe and effective with higher evacuation rate, better functional neurological outcomes, and lower complication and mortality rates.

Introduction

Spontaneous intracerebral hemorrhage (ICH) is a sudden event with an extremely high rate of mortality and disability. ICH accounts for 20% of all the strokes and affects 4 million patients worldwide each year.1, 2 Nonetheless, the incidence has been increasing as the result of an increase in the aging population, as well as an increased use of anticoagulation and antiplatelet agents for thromboembolic diseases.3, 4 The median of the fatality cases at 1 month is up to 40%.5 Moreover, survivors of the event suffer a severe disability, and only 25% of such patients are expected to regain functional independence at 6 months.6, 7

To date, the management of primary supratentorial ICH is controversial. An increasing number of studies aiming to investigate the efficacy of surgical intervention for the treatment of ICH have been carried out; however, diverse results have been obtained.8, 9, 10, 11 Surgery-based approach exhibits the potential to reduce the volume of ICH and might reduce the secondary damage by removing the clots,12, 13 especially in patients with supratentorial lobar intracerebral hematomas.14 Craniotomy has never been the conventional choice for surgical intervention of ICH in the past several decades. However, the prospective randomized controlled trials and the surgical treatment for ICH (STICH) trials have failed to demonstrate that craniotomy could improve the functional outcomes.14, 15

In contrast, recent studies on minimally invasive treatments, including endoscopic surgery (ES) and stereotactic aspiration (SA), have designated such surgical techniques as safe and effective in patients with ICH.16, 17, 18 Hitherto, none of the studies have compared the clinical safety and efficacy of the 3 surgical procedures in patients with spontaneous supratentorial lobar ICH: SA, ES, and craniotomy. Here, we conducted a retrospective study to analyze and compare the therapeutic effect of these 3 surgical approaches in the treatment of spontaneous supratentorial lobar ICH.

Section snippets

Patient Population

A retrospective analysis of case series comprising 99 patients with spontaneous supratentorial lobar ICH who underwent craniotomy, ES, or SA for hematoma evacuation between March 2012 and July 2016 was carried out at the Department of Neurosurgery, Tangdu Hospital of Fourth Military Medical University. All procedures performed were approved by the Institutional Investigational Review Board at the Fourth Military Medical University and the Research Ethics Committee of Tangdu Hospital of Fourth

General Results

According to the inclusion and exclusion criteria, a total of 99 patients with spontaneous supratentorial lobar ICH were included in this study. Thirty-six patients were categorized in the SA group, 32 in the ES group, and the remaining 31 in the craniotomy group. The clinical baseline parameters were shown in Table 1, and these 3 groups were well-matched at baseline. The mean preoperative HV was 53.8 ± 13.5 mL for the SA group, 54.5 ± 14.2 mL for the ES group, and 59.9 ± 14.6 mL for the

Discussion

Unlike intracerebellar hemorrhage in which, there are more defined medical and surgical treatments, surgical intervention of spontaneous supratentorial lobar ICH is still controversial. The present study aimed to evaluate and compare the therapeutic effect of SA, ES, and craniotomy, thereby identifying the optimal surgical procedure. The results suggested that ES is more safe and effective in evacuating spontaneous supratentorial lobar ICH than the other 2 surgical procedures, with a lower rate

Conclusions

The retrospective case series analyzed and compared the safety and efficacy of SA, ES, and craniotomy for the treatment of spontaneous supratentorial lobar ICH. The authors found that SA and ES display an apparent advantage over craniotomy in both short-term and long-term outcomes. Our findings also supplement the evidence supporting the theory that ES is cost-effective, with better functional neurologic outcomes and low rate of complications and mortality.

Acknowledgments

The authors thank Prof. Yangqian for the valuable guidance on the manuscript.

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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

    Yuqian Li, Ruixin Yang, and Zhihong Li contributed equally to this study.

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