Literature ReviewEffect and Feasibility of Endoscopic Surgery in Spontaneous Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis
Introduction
Spontaneous intracerebral hemorrhage (sICH) accounts for about 20% of all stroke types and represents a devastating cerebrovascular disease with high mortality and morbidity. Despite multiple therapeutic modalities accessible, the prognosis remains dismal, especially in patients with a large-volume hematoma. Theoretically, surgical hematoma evacuation would benefit patients by managing intracranial pressure and alleviating the neurotoxic effect of blood breakdown products. Although the craniotomy effectively evacuates hematoma, surgical manipulation causes secondary injury to the vital brain tissue. The supratentorial lobar intracerebral haematomas (STICH) study failed to find a significant superiority of traditional surgery over conservative treatment in reducing death and dependence.1 It is optimal to effectively evacuate hematoma with the least invasiveness.
The minimally invasive surgery, including stereotactic aspiration (SA) and endoscopic surgery (ES), gains increased popularity in sICH. Because the use of SA cannot achieve effective hemostasis in a blind procedure and the use of fibrinolytics is associated with an increased risk of rebleeding, the safety and efficacy of SA are of much concern. In comparison, ES allows for satisfactory hemostasis under endoscopic view and rapid alleviation of mass effect.2 With proficiency in endoscopic manipulation and continual refinement of endoscopic apparatus, ES is widely applied in sICH. Recent studies have suggested ES could improve the outcomes of patients with sICH,3, 4, 5, 6 but the advantage of ES compared with other therapeutic options (craniotomy, conservation, and SA) and the choice of eligible patients to achieve maximum benefit remain controversial. We conducted a systematic review aiming to clarify the application of ES in sICH and compare its therapeutic effect with other treatment options.
Section snippets
Search Strategy
We systematically searched relevant publications through PubMed, Ovid, Web of Science, and Cochrane library databases from inceptions up to October 2017. The search process was restricted to English language and human subjects. The reference lists of retrieved articles were searched manually for eligible studies. A detailed search strategy is described in Appendix 1 and Supplementary Figures 1 and 2. This review was conducted in accordance with the Preferred Reporting Items for Systematic
Literature Search
A total of 986 citations were identified after the removal of duplicates, of which 956 articles were discarded due to irrelevant titles and abstracts. Thirty full-text articles were assessed for eligibility and 12 were excluded for certain reasons. Two studies containing overlapping populations with included studies were not chosen.7, 8 In total, 18 studies were included in the meta-analysis. The detailed screening process is depicted in Figure 1.
Main Characteristics
Six randomized and 12 observational studies were
Discussion
ES has the advantages of being less invasive than craniotomy and more effective than conservation, which seems the optimal treatment modality. This review verified the superiority of ES over craniotomy and conservative treatment in decreasing mortality and poor outcomes. It was noteworthy that most included patients harbored a hematoma volume greater than 50 mL. The large-volume hematoma may indicate the failure of conservation in managing intracranial pressure and aggressive manipulation in
Conclusions
Compared with craniotomy and conservation, ES can effectively decrease mortality, poor functional outcomes, and specific complications and meanwhile improve evacuation rates. Although hematoma volume and stereotactic frame assistance insignificantly influence the therapeutic effect, early surgery appears to offset the advantage of ES. Comparing ES with SA, the functional outcomes and rebleeding rates are similar. ES leads to a greater evacuation rate and SA costs less operative time. The future
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Comparison of endoscopic evacuation, craniotomy, and puncture aspiration for the treatment of spontaneous basal ganglia intracerebral hematoma
2023, Clinical Neurology and NeurosurgeryDevelopment and validation of machine learning prediction model for post-rehabilitation functional outcome after intracerebral hemorrhage
2022, Interdisciplinary Neurosurgery: Advanced Techniques and Case ManagementCitation Excerpt :Third, the timing of acquiring explanatory variables was not limited to immediately after onset. The condition immediately after the onset of ICH fluctuates rapidly; therefore, data acquisition within that period causes overestimation and underestimation [41,42]. These designs based on clinical significance in our model may contribute to accurate predictions.
Neuroendoscopic Surgery versus Craniotomy for Supratentorial Hypertensive Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis
2020, World NeurosurgeryCitation Excerpt :Moreover, the type judgment for one of the included studies13 in their meta-analysis was inaccurate (it should be a nonrandomized controlled trial). Beyond these limitations, in Yao et al.’s study,20 supratentorial hemorrhage was not distinguished from subtentorial hemorrhage. In addition, these investigators combined all the treatment methods (conservation, CT, aspiration, and endoscopic surgery) for the subgroup analysis, which reduced the validity of the results.
Endoscopic surgery for thalamic hemorrhage breaking into ventricles: Comparison of endoscopic surgery, minimally invasive hematoma puncture, and external ventricular drainage
2019, Chinese Journal of Traumatology - English EditionCitation Excerpt :Minimally invasive surgery, including endoscopic surgery (ES) and hematoma puncture and drainage (HPD), has great potential for the treatment of deep cerebral hematomas and may improve patient prognosis.8–11 The development of neuroendoscopy technology allows surgery in long and slender channels with good illumination and multi-angle vision, which facilitates the treatment of deep hematomas without increasing the complication rate.12–14 Chen et al.15,16 used ES to remove ventricular & lateral thalamic hematomas and showed that the incidence of shunt-dependent hydrocephalus was significantly lower compared with EVD surgery.
Supplementary digital content available online.
Conflict of interest statement: This work was funded by Science and Technology Supportive Project of Sichuan Province (No. 2015SZ0051) and 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (No. ZY2016102).