Original Article
Early Recovery and Better Evacuation Rate in Neuroendoscopic Surgery for Spontaneous Intracerebral Hemorrhage Using a Multifunctional Cannula: Preliminary Study in Comparison With Craniotomy

https://doi.org/10.1016/j.jstrokecerebrovasdis.2009.11.021Get rights and content

Neuroendoscopy is a promising therapeutic option for spontaneous intracerebral hemorrhage (ICH). We sought to compare the clinical outcomes between neuroendoscopic surgery and craniotomy for spontaneous ICH. We retrospectively analyzed the clinical and radiographic data of 43 patients treated with 23 neuroendoscopic procedures (endoscopy group) and 20 microsurgical procedures (craniotomy group). Rebleeding rate, surgical complications, and/or death were identified as primary clinical endpoints during the 2-month postoperative follow-up period. Evacuation rate, Glasgow Coma Scale (GCS) score at day 7, and Glasgow Outcome Scale (GOS) score were compared as well. A composite primary endpoint was observed in 5 cases (11.6%), including 1 postoperative death in the endoscopy group (4.3%) and 4 postoperative deaths in the craniotomy group (20.0%). No rebleeding was observed in the endoscopy group. The evacuation rate was significantly higher in the endoscopy group compared with the craniotomy group (99.0% vs 95.9%; P < .01). Mean GCS score at day 7 was 12 for the endoscopy group and 9.1 for the craniotomy group (P < .05). The mean change in GCS score was +4.8 for the endoscopy group and −0.1 for the craniotomy group (P < .001). Our data indicate that in patients with ICH, endoscopic surgery is safe and feasible, and may promote earlier recovery. Our results warrant a future prospective, randomized, controlled efficacy trial.

Section snippets

Materials and Methods

The study group (endoscopy group) consisted of 23 consecutive adult patients between April 2006 and February 2009 (Table 1). Some of the cases in this group were reported previously.1, 2 The endoscopy group was matched to a historical control group (craniotomy group), a series of 20 consecutive patients treated by craniotomy at our institution between January 2004 and April 2006. The preoperative and postoperative treatments, including blood pressure management, were identical for all 43

Case 1

A 58-year-old man was brought to the hospital after sudden onset of right hemiparesis and aphasia. On initial consultation, his level of consciousness was E3V2M4 on the GCS. Head CT revealed left ICH in the putamen, with an estimated volume of 120 mL (Fig 1A). The patient's level of consciousness deteriorated to E1V1M2 and his left pupil was dilated; thus, hematoma evacuation was performed. Postoperative CT confirmed complete removal of the hematoma (Fig 1B). Right hemiparesis and aphasia

Results

Twenty-three consecutive cases of endoscopic surgery (endoscopy group) and 20 historical controls (craniotomy group) were evaluated. All patients had altered level of consciousness with or without focal neurologic deficit. Baseline characteristics are summarized in Table 1. More than half of the group was male, and the mean patient age was 60.9 years (range, 33-85 years). The median time from ictus to surgery was 4 hours in the endoscopy group and 6 hours in the craniotomy group. Hematoma

Surgical Treatment of ICH

The role of surgery in treating ICH is not fully established. Surgical evacuation of the intracerebral hematoma is based on the concept of reducing mass effect and thus decreasing ICP, improving regional blood flow, and restricting the release of toxic breakdown products by the clot.17 Possible negative side effects include the additional trauma caused by the procedure itself and possibly an increased risk of rebleeding due to removal of the tamponade provided by the hematoma.17

Results from the

Conclusion

In our cohort, neuroendoscopic surgery significantly improved the hematoma evacuation rate and GCS score at day 7 in patients with ICH. Our findings indicate that neuroendoscopic surgery is safe and feasible and may promote early recovery of patients with spontaneous ICH. They support the idea that neuroendoscopic surgery can play a crucial role in the treatment of spontaneous ICH at a hyperacute stage. Our results warrant a future prospective, randomized, controlled efficacy trial.

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    • Cited by (0)

    Supported by a grant from the Japanese Foundation for Research and Promotion of Endoscopy.

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