Curative effect analysis of neuroendoscopic surgery via superior frontal sulcus in the treatment of hypertensive intracerebral hemorrhage

Objective To investigate the Effects of conventional open craniotomy and key-hole approach on neurosurgical management of hypertensive intracerebral hemorrhage (HICH) and on cellular immunal function of these patients.Methods Eighty-three patients with HICH,admitted to and performed operation in our hospital from September 2008 to May 2011 (53 underwent conventional open craniotomy and 30 underwent surgery via key hole approach) were chosen in our study.Their CD3,CD4 and CD8 positive cell percentage and ratio of CD4/CD8 in serum before operation and 1 and 7 d after operation were detected.The infectious complications were analyzed and prognoses were evaluated by activities of daily living (ADL) grading.Results The CD3 and CD8 positive cell percentage,and ratio of CD4/CD8 in serum 1 and 7 d after the operation were significantly decreased as compared with those before operation (P＜0.05),and those 7 d after operation were significantly increased as compared with those 1 d after operation (P＜0.05).One and 7 d after operation,the CD3 and CD8 positive cell percentage,and ratio of CD4/CD8 in the key hole approach group were significantly higher than those in the conventional open craniotomy group (P＜0.05).The postoperative pulmonary infection rate in the conventional open craniotomy group was significantly higher than that in the key hole approach group (P＜0.05).Conclusion As compared with conventional open craniotomy,surgery via key-hole approach has the same prognosis in treatment of HICH which has not yet occurred herniation,while the influence of cellular immunal function and the incidence of lung infection is relatively lower. Key words: Hypertensive intracerebral hemorrhage; Operation therapy; Cellular immunal function

Objective To investigate the therapeutic effects of neuroendoscopic surgery and craniotomy in the treatment of hypertensive intracerebral hemorrhage(HIH). Methods A total of 54 patients with hypertensive intracerebral hemorrhage treated by operation between May 2011 and June 2013 were analyzed retrospectively, 28 patients in neuroendoscopy group and 26 patients in craniotomy group.All patients were followed up for 3 months, two groups were estimated by the ADL scores, grade 1-3 of ADL was regarded as good prognosis, grade 4-5 of ADL and dead cases as poor prognosis. Results One death case in the neuroendoscopy group and 2 death cases in the craniotomy group, no statistical difference (P>0.05). The good prognosis rate of ADL was 82.1% (23/28) in the neuroendoscopy group and 53.9% (14/26) in the craniotomy group, the therapeutic effects of neuroendoscopy group were better than those of craniotomy group(P>0.05). Conclusion Neuroendoscopic surgery is a kind of method with little injury、favorable recovery of neural function in the treatment of hypertensive intracerebral hemorrhage. Key words: Hypertensive intracerebral hemorrhage; Neuroendoscope; Craniotomy

Objective To study the clinical value and efficacy of intracranial hemorrhage smash puncture needle with YL-1 type disposable under CT monitoring in treatment of hypertensive intracerebral hemorrhage.Methods The data of 80 cases with hypertensive intracerebral hemorrhage patients who accepted the transcranial puncture under CT monitoring application of YL-1 type disposable intracranial hemorrhage smash puncture needle and drainage of hemorrhage,punctuated with urokinase washout and drainaged residual blood clot.Evaluation criteria:hemorrhage volume reduction,average operation time,preoperative and postoperative Glasgow coma scale (GCS) score,the clinical effect of long-term follow-up.Results Operation time was 15-45 (25.0 ± 2.8) minutes;hemorrhage volume was reduced by an average of 30％-80％ (56.8 ± 3.2)％,the average increase of GCS was (2.3 ±0.3) scores,10 cases death in 80 patients,70 survivors' activities of daily living (ADL) assessments:grade ADL 1 in 17 cases ( 24.3 ％ ),grade ADL2 in 36 cases( 51.4％ ),grade ADL3 in 13 cases ( 18.6％ ),grade ADL4 in 3 cases(4.3％ ),grade ADL5 in 1 case ( 1.4％ ).Conclusions YL-1 type disposable intracranial hemorrhage smash puncture needle under CT monitoring in the treatment of hypertensive intracerebral hemorrhage is a simple,fast and accurate positioning,without craniotomy and blood transfusion,safe and effective operation,but should pay attention to operation indications. Key words: Intracranial hemorrhage,hypertensive; Punctures; Hard puncture needle passage

Objective To investigate the efficacy of neuroendoscopy combined with neuronavigation in the treatment of hypertensive intracerebral hemorrhage (HICH). Methods A retrospective analysis was conducted on 96 patients with HICH who underwent treatment at Department of Neurosurgery, the Affiliated Dalian Central Hospital of Dalian Medical University from January 2015 to January 2017. All cases were divided into endoscopic navigation group (n=44) and microscopy group (n=51) based on the treatment method. The endpoints including hematoma clearance rate, intraoperative blood loss, operation time, postoperative hospitalization and hospitalization expenses were analyzed and compared between the 2 groups. The Glasgow outcome scale (GOS) was used for assessment at a 6-month follow-up. Results Hematoma clearance rate in endoscopic navigation group was higher than that in microscopy group (91.5±6.0 % vs. 83.7±6.8 %, P<0.001), while intraoperative blood loss(74.1±14.0 ml vs. 224.9±32.6 ml), operation time(69.6±13.7 min vs.128.2±28.4 min), postoperative hospitalization(12.4±2.8 d vs.18.3±2.4 d), and hospitalization expenses(38 600±9 600 yuan vs. 52 300±11 200 yuan) in endoscopic navigation group were significantly lower than those in microscopy group (all P<0.001). At the 6-month follow-up, the score of GOS in endoscopic navigation group was significantly better than that in microscopy group (P=0.029). Conclusion Treatment of HICH using neuroendoscopy combined with neuronavigation seems to be featured with less trauma, good efficacy, good prognosis and low costs, which is thus worth being applied and promoted in clinical practice. Key words: Natural orifice endoscopic surgery; Intracranial hemorrhage, hypertensive; Neurosurgical procedures; Neuronavigation; Treatment outcome

Objective To study the efficacy of two different modes of surgical intervention for the treatment of hypertensive intracerebral hemorrhage (HICH): YL-1 type hematoma removed by needle aspiration plus bio-enzyme liquefaction versus conventional craniectomy plus hematoma evacuation. Methods Medical records of 23 patients with HICH treated from December 2012 to February 2017 were retrospectively analyzed. The differences in demographics, length of operation time, costs and length of hospital stay, Glasgow Outcome Scale scores and 3-month follow-up results were compared between the YL-1 type hematoma removed by needle aspiration plus bio-enzyme liquefaction in 12 patients and conventional craniectomy plus hematoma evacuation in 11 patients. Results There were no significant differences in the gender (male 58.33% vs. 63.64%, femal 41.67% vs. 36.36%) , age (65.5±11.8 years vs. 56.8±10.1 years), preoperative GCS (6.83±3.93 vs. 5.82±3.40), intracranial hematoma volume (50.52±23.07 mL vs. 68.77±11.18 mL) and length of hospital stay (15.58±14.72 days vs. 22.45±18.37 days) (P>0.05); There were statistically significant differences in length of operation time (0.73±0.21 h vs. 3.92±0.67 h) and hospitalization costs (45 230.50±36 566.88 yuan of RMB vs. 79 857.90±34 916.48 yuan of RMB) between two groups (P 0.05). Conclusions The minimally invasive YL-1 type hematoma aspiration procedure with bio-enzyme liquefaction as a minimally invasive surgery may be superior to conventional craniectomy for treating HICH because it can offer shorter operation time, more accurate hematoma localization, lower risk of injury, and lower hospitalization costs. In particular, the procedure is suitable for elderly, frail, and poor general condition patients. It can also be applied as emergency treatment for HICH. Key words: Hypertensive intracerebral hemorrhage; Decompressive craniectomy; Minimally invasive surgery; YL -1 intracranial hematoma puncture needle therapy; Bio-enzyme liquefaction; Urokinase; Hematoma localization; Rehemorrhage

Objective To compare the surgical outcome of intracerebral hematoma drilling and drainage for hypertensive intracerebral hemorrhage (HICH) using robotized stereotactic assistant(ROSA)-assisted and stereotactic framework. Methods A retrospective study was conducted on 368 patients with HICH who underwent hematoma drilling at Department of Neurosurgery, General Hospital of Shenyang Military Command from March 2015 to April 2017. According to the surgical method, all cases were divided into the stereotactic frame group (group A) and ROSA group (group B). Comparison was conducted on the treatment outcome of those 2 surgical methods for HICH. Results There was no statistically significant difference in gender, age, preoperative GCS (Glasgow coma scale), time interval from bleeding to operation and bleeding volume between 2 groups (all P>0.05). The operating time (27.3±8.4 min) and incidence of rebleeding (1.7%, 3/172) were lower in group B than those in group A [operation time: (44.2±7.7) min, incidence of rebleeding: 8.7% (17/196)] (both P<0.01). In group A, 12 (6.1%) patients developed postoperative intracranial infection and none had intracranial infection in group B and there was statistically significant difference between the 2 groups (P=0.001). The extubation time in groups A and B was (2.5±0.7) days and (1.2±0.5) days post opeartion, respectively, which were significantly different (P<0.001). The 30-day mortality rate in group B (2.3%, 4/172) was lower than that in group A (9.2%, 18/196) (P=0.006). Conclusion Compared with stereotactic frame-assisted surgery, ROSA-assisted operation seems to be associated with shorter operation duration, earlier extubation time, and lower incidence of postoperative rebleeding, intracranial infection and 30-day mortality rate for HICH patients, which is thus worthy of clinical promotion. Key words: Intracranial hemorrhage, hypertensive; Neurosurgical procedures; Treatment outcome; Robotized stereotactic assistant; Stereotactic frame

Objective To explore and analyze the safety , feasibility and efficacy of CT-guided minimally invasive positioning hole drainage in the treatment of hypertensive intracerebral hemorrhage .Methods 100 cases with hypertensive intracerebral hemorrhage were selected as the research subjects , according to a random number table method,the patients were randomly divided into the control group and observation group ,50 cases in each group.Pa-tients in the observation group were given early CT-guided minimally invasive positioning drill drainage 6-12h after the onset,and patients in the control group received conservative treatment .Results After treatment,daily living activi-ties of patients graded as grade Ⅰ,Ⅱin the observation group were 17 cases,19 cases,which were significantly more than those in the control group （6 cases,9 cases）,while the number of grade Ⅲ15 cases in the control group was sig-nificantly more than 7 cases in the observation group .The excellent rate of the observation group was 86%,which was significantly higher than 60%of the control group .The time of consciousness recovery ,average catheter time ,hospital stay in the observation group were （11.2 ±2.2）h,（4.1 ±1.5）d,（6.2 ±2.4）d,which were significantly shorter than those in the control group [（17.4 ±2.8）h,（6.2 ±2.1）d,（11.1 ±1.8）d].The total effective rate of the ob-servation group was 82%,which was significantly higher than 52% of the control group （χ2 =10.15,P〈0.05）. Conclusion Early minimally invasive drilling drainage under CT guidance positioning in the treatment of patients with hypertensive intracerebral hemorrhage has significant effect ,it is safe and can improve the survival and life quali-ty of patients after surgery ,which is worth promoting . Key words: Intracranial hemorrhage, hypertensive ; Minimally invasive drilling drainage ; Tomography, X-raycomputed

Objective To evaluate the efficacy of stereotactic hematoma evacuation surgery for hypertensive cerebral hemorrhage in basal ganglia region. Methods A retrospective analysis was performed on 65 cases of hypertensive cerebral hemorrhage in the basal ganglia from August 2015 to March 2018 at the Stereotactic and Neurofunctional Center of the 306th Hospital of PLA. According to different surgical methods, those patients were divided into 2 groups. In the hematoma puncture group, 35 patients underwent hematoma puncture and drainage surgery; in the stereotaxis group, 30 patients underwent stereotactic puncture and catheter drainage surgery assisted by robot Remebot. The baseline conditions, bleeding time, volume of hematoma, preoperative GCS (Glasgow coma scale) score, Barthel score before discharge and at 3 months post operation, and the time of thorough hematoma drainage were compared between the 2 groups. Results (1) The time for thorough hematoma drainage in the stereotaxis group was significantly less than that in the hematoma puncture group. There was a significant difference between the 2 groups (Z=3.69, P<0.01). (2) Barthel scores before discharge (89.7±7.2) and at 3 months post operation (94.0±5.7) in stereotaxis group were significantly higher than those in hematoma puncture group (before discharge: 75.3±7.2, 3 months post operation: 76.4±8.2, both P<0.01). Conclusion Stereotactic hematoma evacuation surgery could significantly accelerate the removal time of hematoma in patients with hypertensive intracerebral hemorrhage, quickly relieve the compression of brain tissue by hematoma and promote the recovery of neurological function. Key words: Intracranial hemorrhage, hypertensive; Basal ganglia; Neurosurgical procedures; Stereotactic; Treatment outcome

Objective To evaluate the effect of aescine sodium combined with albumin in the treatment of hypertensive intracerebral hemorrhage after intracranial hematoma minimally invasive removal surgery. Methods 50 patients with hypertensive intracerebral hemorrhage after intracranial hematoma minimally invasive removal surgery were randomly divided into the two groups: the treatment group was treated with aescine sodium and albumin, the control group was treated with the conventional medical drugs; The neural function defect scale, brain edema area of postoperative patients after 1d and 15d, clinical effects after 15d were observed. Results 15d after operation,in the treatment group,the brain edema area was(2.40±0.32)cm2, neural function defect scale was(9.44±2.25)points, which were better than(3.40±0.85)cm2(t= 4.721,P< 0.01)and(15.65 ±3.04)points(t= 3.625,P< 0.01). The total effective rate of the treatment group was 88.9%,which was better than 69.6% of the control group(χ2= 13.58,P< 0.01). Conclusion Aescine sodium combined with albumin can effectively reduce perihematomal brain edema area, improve nerve function defect and clinical effect in the patients with hypertensive cerebral hemorrhage after minimally invasive scavenging surgery. Key words: Cerebral Hemorrhage; Hematoma; Aescine sodium; Albumins

Objective To investigate the effect of soft channel minimally invasive treatment on hypertensive intracerebral hemorrhage (HICH) and its influence on serum interleukin-18 (IL-18), vascular endothelial growth factor (VEGF), C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α). Methods From April 2017 to April 2019, 82 patients with HICH admitted to Taizhou Hospital of Traditional Chinese Medicine were randomly divided into observation group (41 cases) and control group (41 cases) according to random number table method.The control group was treated with hard channel minimally invasive treatment, while the observation group was treated with soft channel minimally invasive treatment.The therapeutic effect, intracranial hematoma volume, serum levels of IL-18, VEGF, CRP and TNF-α before and 7 days after operation, neurological deficit degree (NIHSS) scores before and 3 months after operation, and complications after operation were compared between the two groups. Results The total effective rate of the observation group (92.68%) was higher than that of the control group (70.73%) (χ2=6.609, P<0.05). The amount of intracranial hematoma in the observation group [(4.03±1.10)mL] was lower than that in the control group [(7.17±1.36)mL] (t=11.495, P<0.05). At 7 d after operation, the serum levels of IL-18[(123.74±10.27)ng/L], VEGF[(113.28±12.10)ng/L], CRP[(17.83±3.20)mg/L] and TNF-α[(0.65±0.12)ng/L] in the observation group were lower than those in the control group [(150.38±13.21)ng/L, (141.63±16.87)ng/L, (29.96±4.53)mg/L and (1.09±0.17)ng/L] (t=11.638, 9.101, 13.831, 5.569, all P<0.05). The NIHSS score of the observation group[(16.53±3.19)points] was lower than that of the control group[(23.43±4.65)points] at 3 months after operation (t=7.824, P<0.05). The incidence of complications in the observation group (12.20%) was lower than that in the control group (34.15%) (χ2=5.549, P<0.05). Conclusion Soft channel minimally invasive treatment for HICH has good effect and can reduce the changes of serum levels of IL-18, VEGF, CRP and TNF-α. Key words: Intracranial hemorrhage, hypertensive; Surgical procedures, minimally invasive; Soft channel minimally invasive; Hard channel minimally invasive; Interleukin-18; Vascular endothelial growth factor; C-reactive protein; Tumor necrosis factor-α

Objective To investigate the effects of early minimally invasive intracranial hematoma removal on hypertensive intracerebral hemorrhage and the levels of C-reactive protein (CRP), interleukin-4 (IL-4) and interleukin-10 (IL-10). Methods Eighty-four patients with hypertensive cerebral hemorrhage were analyzed retrospectively. Patients were randomly divided into control group and study group according to treatment methods, with 42 cases in each group. The control group was treated with scavenging of bone window hematoma, and the study group was treated with early minimally invasive intracranial hematoma removal, all patients were followed up for two weeks. The clinical effects of two groups were compared, the levels of serum CRP, IL-4, IL-10 before and after treatment, the condition of nerve function defect and the incidence of complications before and after treatment were compared between the two groups. Results The total effective rate of treatment in study group was 95.24% (40/42), which was significantly higher than that of control group [(78.57% (33/42)], and the difference was statistically significant (P<0.05). After treatment, serum CRP, IL-4, IL-10 levels in study group were (13.7±3.5) mg/L, (15.4±3.6)ng/L, (10.1±2.2)ng/L, which were significantly lower than those in control group (16.8±4.1)mg/L, (18.2±4.0)ng/L, (14.3±2.6)ng/L, there was a statistically significant difference (P<0.05). At 1 and 2 weeks after treatment, the NIHSS scores in study group were (24.4±3.4) and (9.4±2.2) respectively, which were significantly lower than those in control group (33.2±4.1, 14.5±3.1), the difference was statistically significant (P<0.05). The incidence of complications in study group (4.76%) was significantly lower than that of control group (21.43%), the difference was statistically significant (P<0.05). Conclusions Early minimally invasive intracranial hematoma is effective in the treatment of hypertensive intracerebral hemorrhage, and it can effectively control the levels of CRP, IL-4 and IL-10, promote the recovery of neurological function, and reduce the incidence of complications. It is worth popularizing in clinical application. Key words: Hypertensive intracerebral hemorrhage; Early minimally invasive intracranial hematoma removal; Efficacy; Inflammatory factors; Nerve function

Objective To investigate the clinical effect of stereotactic intracranial hematoma aspiration for patients with hypertensive intracerebral hemorrhage (HICH). Methods 100 patients with HICH in our hospital from August 2015 to March 2016 were randomly divided into two groups. The patients in craniotomy group were treated with conventional craniotomy, while the patients in stereotactic group were treated with stereotactic intracranial hematoma aspiration. Analyzed the physical dysfunction grade distribution, comatose state before and after treatment, the recovery effect, the overall treatment effect, postoperative complications of two groups. Results The physical dysfunction grade distribution in stereotactic group was significantly better than that in craniotomy group, with statistically significant difference (P<0.05). GCS score and GOS-E score in stereotactic group were higher than those in craniotomy group, with statistically significant differences (P<0.01). The total efficiency in stereotactic group was significantly higher than that in craniotomy group, with statistically significant difference (P<0.01). The incidence of gastrointestinal bleeding and secondary hemorrhage in stereotactic group were significantly lower than those in craniotomy group, with statistically significant differences (P<0.05); the overall incidence of complications in stereotactic group was significantly lower than that in craniotomy group, with statistically significant difference (P<0.01). Conclusion Stereotactic intracranial hematoma aspiration has significant clinical effect in patients with hypertensive intracerebral hemorrhage, of higher security, with great clinical significance. Key words: Hypertensive intracerebral hemorrhage; Stereotactic intracranial hematoma aspiration; Physical dysfunction; Complication

Objective To compare the clinical effect of minimally invasive operation and conservative treatment on hypertensive intracerebral hemorrhage. Methods From January 2015 to January 2018, 85 patients with hypertensive intracerebral hemorrhagein in Gujiao Mining Area General Hospital of Xishan Coal and Electricity Group were selected.According to the treatment methods, the patients were divided into two groups: the minimally invasive operation group(n=46) and the conservative treatment group(n=39). The minimally invasive operation group was treated with minimally invasive surgery, and the conservative treatment group was treated with the conservative therapy of neurology.The clinical efficacy and hospital stay of the two groups were compared.The incidence of complications, neurological impairment score, ADL score and prognosis of the teo groups were compared. Results The total effective rate of the minimally invasive surgery group was 95.65%, which was higher than 79.49% of the conservative treatment group(χ2=5.586, P<0.05). The length of hospitalization in the minimally invasive surgery group was (8.52±2.31)d, which was significantly shorter than (11.79±3.05)d in the control group (t=5.617, P<0.05). The incidence rate of complication of the minimally invasive surgery group was 6.52%, which was lower than 25.64% of the conservative treatment group(χ2=5.955, P<0.05). After treatment, the nerve function defect score of the two groups was significantly reduced (t=9.455, 16.773, all P<0.05), the daily life ability score was significantly increased (t=8.372, 14.085, all P<0.05), which in the invasive surgery group were better than those in the conservative treatment group(t=6.974, 5.063, all P<0.05). The good prognosis rate of the minimally invasive surgery group was 67.39%(31/46), which was significantly higher than 43.59%(17/39) of the conservative treatment group (χ2=4.864, P<0.05). Conclusion Minimally invasive surgery is superior to conservative treatment in the treatment of hypertensive intracerebral hemorrhage. Key words: Cerebral hemorrhage; Hypertension; Surgical procedures, minimally invasive; Controlled clinical trial

Objective To compare the effect of minimally invasive hematoma the quenching aspiration and hematoma evacuation in the treatment of hypertensive basal ganglia brain hemorrhage.Methods 92 patients with hypertensive cerebral basal ganglia hemorrhage underwent surgical treatment were randomly divided into two groups:minimally invasive quenching suction group of 46 patients,craniotomy group of 46 patients.The mortality,complications and activities of daily living(ADL) postoperative three months were observed.Results The mortality rate of the minimally invasive quenching suck group was lower than that of the craniotomy group (8.7％ vs 21.7％,P ＜ 0.05).The postoperative rebleeding and the incidence rate of complications such as lung infections in the minimally invasive quenching suction group were lower than those of the craniotomy group(all P ＜ 0.05).ADL score 3 months postoperatively of the minimally invasive quenching suction group was higher than that of the craniotomy group [(85.53 ± 13.47) points vs (56.12 ± 11.72) points,P ＜ 0.05].Conclusion Minimally invasive hematoma the quenched aspiration in treatment of hypertensive basal ganglia brain bleeding trauma can reduce the mortality,reduce the occurrence of postoperative complications,increase quality of life in patients,has better efficacy for treatment of hypertensive intracerebral hemorrhage. Key words: Surgical procedures, minimally invasive ; Neurosurgical procedures ; Hypertensive intracranial hemorrhage

Objective To observe the change of intracranial pressure in the treatment of hypertensive intracerebral hemorrhage (HICH) by observing continuous intracranial pressure (ICP), to guide the application and adjustment of dehydrating agent, to analyze the clinical curative effect and evaluate its clinical application value. Methods 86 patients with hypertensive intracerebral hemorrhage (HICH) were enrolled in this study from June 2014 to June 2016. The patients were randomly divided into two groups according to the digital table method. 43 patients in the control group were treated with basic therapy and mannitol; 43 patients in the observation group received intracranial pressure monitoring on the basis of the control group, adjusting mannitol dosage and treatment options in accordance with the changes of monitoring data. And the clinical effect of the two groups were compared. Results After 6 months of treatment, the good rate of the observation group was 58.14%, and significantly higher than 32.56% of the control group (χ2=5.6770, P<0.05). The average total amount of mannitol in the observation group was significantly lower than that in the control group (P<0.05). The incidences of electrolyte imbalance, pulmonary infection, renal dysfunction, stress ulcer, and recurrent cerebral hemorrhage in the observation group in the duration of hospital stay were significantly lower than those in the control group (P<0.05). Conclusion In patients with HICH, continuous ICP monitoring can effectively guide the flexible use of dehydrating agent, significantly reduce the incidence of complications, significantly improve the prognosis, which has become a more ideal adjuvant therapy in the cerebral surgery. Key words: Hypertensive intracerebral hemorrhage; Continuous intracranial pressure monitoring; Treatment