Endoscopic Surgery Without Decompressive Craniectomy in Large Putaminal Intracerebral Hemorrhage: Assessment of Efficacy and Safety

Yuanliang Ye,Zhenhui Zhao,Weiyang Ou,Jian He,Qiujing Wang

doi:10.1007/s12028-019-00880-8

Yuanliang Ye, Zhenhui Zhao + Show 3 more

Open Access

https://doi.org/10.1007/s12028-019-00880-8

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Abstract

BackgroundDecompressive craniectomy (DC) is performed conventionally for large putaminal intracerebral hemorrhage (ICH). However, DC causes local skull defect and leads to post-surgical cranioplasty. The aim of this study is to investigate the effectiveness and safety of an endoscopic procedure to treat large putaminal ICH without DC.MethodsThis retrospective study included 112 large putaminal ICH patients who underwent hematoma evacuations with either an endoscopic procedure (group A) or with DC (group B) between January 2009 and June 2017. The efficacy was evaluated by mean modified Rankin Scale (mRS) three months after surgery. Safety was evaluated by mortality rate and postoperative complications. Univariate and multivariate logistic regression analyses were performed to determine the risk factors for clinical outcomes.ResultsThe study included 49 patients in group A and 63 in group B. The mRS scores in both groups were similar after 3 months’ follow-up (p = 0.709). There was no difference in the mortality rate between the two groups (p = 0.538). The rate of complications was lower in group A than that in group B (p = 0.024). Smaller preoperative midline shift (p = 0.008) and absent intraventricular extension (p = 0.044) have contributed significantly to better outcomes.ConclusionEndoscopic hematoma evacuation without DC is safe and effective for patients with large putaminal ICH and deserves further investigation, preferably in a randomized controlled setting.

Highlights

Spontaneous intracerebral hemorrhage (ICH) is one of the most deadly forms of stroke with an extremely high mortality rate [1, 2]
The International Surgical Trial in Intracerebral Hemorrhage study showed that emergency surgical hematoma evacuation failed to improve the outcome of ICH patient comparing with the same type of patients who received initial medical management without surgery [8], surgical treatment of large ICH has been considered as a life-saving intervention
There were 49 patients suffering from large ICH in group A and 63 patients in group B

Summary

Introduction

Spontaneous intracerebral hemorrhage (ICH) is one of the most deadly forms of stroke with an extremely high mortality rate [1, 2]. The International Surgical Trial in Intracerebral Hemorrhage study showed that emergency surgical hematoma evacuation failed to improve the outcome of ICH patient comparing with the same type of patients who received initial medical management without surgery [8], surgical treatment of large ICH has been considered as a life-saving intervention. Endoscopic hematoma evacuation has become well received for its high evacuation rate and less complication, especially in patients with moderatesized hematoma [14]. We applied endoscopic surgery without DC for patients with large putaminal ICH and assessed the efficacy and safety of this procedure. Decompressive craniectomy (DC) is performed conventionally for large putaminal intracerebral hemorrhage (ICH).

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