Elsevier

World Neurosurgery

Volume 114, June 2018, Pages e60-e65
World Neurosurgery

Original Article
Surgical Management of Supratentorial Intracerebral Hemorrhages: Endoscopic Versus Open Surgery

https://doi.org/10.1016/j.wneu.2018.02.056Get rights and content

Highlights

  • No standard treatment or surgical procedure has been identified for intracerebral hemorrhages.

  • We compared intracerebral hematoma drainage in 2 groups treated with endoscopic method versus craniotomy.

  • The minimally invasive neuroendoscopic method achieved acceptable morbidity and mortality rates.

  • Endoscopic hematoma evacuation may be a good alternative for treating supratentorial spontaneous cerebral hematomas.

Objective

Intracerebral hemorrhage continues to be a major global problem. No standard treatment or surgical procedure has been identified for intracerebral hemorrhages. High morbidity and mortality rates caused by conventional approaches and the disease itself have necessitated more-invasive treatment methods. The endoscopic approach is a more minimally invasive method than craniotomy, which is another alternative surgical treatment.

Methods

We compared intracerebral hematoma drainage in 2 groups of 17 patients each, treated with minimally invasive endoscopic method versus craniotomy. All the patients were treated for supratentorial spontaneous hemorrhage between December 2013 and February 2017 at the Neurosurgery Clinic of Ankara University Faculty of Medicine.

Results

We retrospectively evaluated 34 patients surgically treated between December 2013 and February 2017. All patients underwent surgery within the first 24 hours. Patients in the early surgery group had better surgical outcomes. In the neuroendoscopic group, Glasgow Coma Scale increased from 6 to 11 at 1 week postoperatively compared with 5 to 9 in the craniotomy group.

Conclusions

Minimally invasive endoscopic hematoma evacuation may be a good alternative surgical method for treating supratentorial spontaneous cerebral hematomas.

Introduction

Hypertensive hemorrhage is the second most common but most fatal type of stroke in the world1 and is observed in 24.6 of 100,000 people.2 The most important prognostic factor for intracerebral hemorrhage (ICH) is hypertension (HT),3 with 30-day and annual mortality rates of 40% and 50%, respectively.4, 5 Morbidity and leave sequelae range at approximately 80%. In patients with long-term intensive care follow-up, mortality rates may increase up to 60%–80%. Approximately 24% of patients experience rebleeding.6 Patient hospitalization has become longer, and care costs have increased accordingly.

Ventricular bleeding and old age are associated with poor prognosis.5 ICH is more frequently observed in men,2 and no definitive treatment algorithm currently exists.7 In the surgical treatment for ICH in the Surgical Trial in Intracerebral Haemorrhage (STICH) study, early surgery has shown a 2.3% benefit but without overall statistical significance.8 However, STICH 2 has demonstrated early surgery to be partially beneficial in cases of superficial cortex-located hematomas without ventricular hemorrhage.9 The number of studies showing that neuroendoscopic (NE) hematoma evacuation is less invasive and more effective is currently increasing.10, 11, 12 We compared NE hematoma evacuation and craniotomy in patients with intracerebral hematoma and observed the efficiency of these procedures.

Section snippets

Selection of Patients

Between December 2013 and February 2017, 34 patients treated for ICH were evaluated retrospectively at the Neurosurgery Clinic of Ankara University Faculty of Medicine: 17 (10 men) underwent craniotomy, and 17 (12 men) underwent NE surgery. Good Clinical Practice standards and the Declaration of Helsinki approval certificates were obtained. Informed consent was obtained for each patient from their first-degree family members.

Hematoma size was evaluated preoperatively and postoperatively by

Results

We retrospectively evaluated 34 patients (22 males and 12 females) surgically treated between December 2013 and February 2017 (Table 1). Bleeding was located in the putamen, thalamic and subcortical areas in 17, 11 and 6 patients, respectively. No significant difference was observed in the location and size of the hematomas or patient age (P > 0.05). Ventricular hemorrhage occurred in 7 patients in the NE group and in 8 in the craniotomy group.

All patients underwent surgery within the first 24

Discussion

Treatment of intracerebral hematomas remains controversial.7 The growing popularity of medical technologies and minimally invasive methods has led to the use of endoscopy to treat ICH.14 The first endoscopic approaches to treat ICH were performed by Auer et al.15 In their study, mortality rates were 70% in the medical treatment group and 30% in the endoscopic group.

Brain damage after ICH is due to toxic effects of the blood and mechanical compression.1 The primary goal of surgery is to reduce

Conclusions

Cerebral hematoma treatment always has been controversial for neurosurgeons in terms of indications and surgical planning. As demonstrated in our series, minimally invasive endoscopic hematoma evacuation is a good alternative surgical method for treating supratentorial spontaneous cerebral hematomas.

Acknowledgments

Preparation for publication of this article was partly supported by Turkish Neurosurgical Society.

References (22)

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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.

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