Hemorrhagic stroke treated by transcranial neuroendoscopic approach

Qiang Cai,Qianxue Chen,Junhui Liu,Zhiyang Li,Wenju Wang,Baowei Ji,Shanping Mao,Zhibiao Chen

doi:10.1038/s41598-021-90927-8

Qiang Cai, Qianxue Chen + Show 6 more

Open Access

https://doi.org/10.1038/s41598-021-90927-8

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Abstract

Hemorrhagic stroke (HS) is usually treated under microscopy, but recently, an increasing number of cases have been treated under neuroendoscopy. The objective of this study was to explore the feasibility and efficacy of a transcranial neuroendoscopic approach for HS. Based on etiology and clinical features, 203 HS patients were classified into two groups, with 100 patients in the primary HS (PHS) group and 103 patients in the secondary HS (SHS) group. All patients were treated either by full neuroendoscopy (FNE) or by neuroendoscopy combined with microsurgery (ECM). Outcomes were assessed according to the Glasgow Coma Scale (GCS) at discharge, and the rate of good plus excellent results was recorded as the GE rate to assess the treatment effect. All 203 patients underwent surgery successfully, with 165 patients who underwent FNE and 38 patients who underwent ECM. No patients died within 3 days after surgery, and the surgery-related mortality rate was 0%, but a total of 4 patients died by discharge, and the overall mortality rate was 1.97%. A total of 133 patients showed an excellent result and 16 showed a good result, for a total GE rate of 73%. Neuroendoscopy can provide excellent illumination, clear visualization, and multiangle views in HS. The transcranial neuroendoscopic approach is feasible and safe for both PHS and SHS and is very effective for hematoma evacuation. However, some aneurysms and most arteriovenous malformations and arteriovenous fistulas require ECM.

Highlights

Hemorrhagic stroke (HS) is usually treated under microscopy, but recently, an increasing number of cases have been treated under neuroendoscopy
intracerebral hemorrhage (ICH) can be classified into primary and secondary ICH based on the etiology, while subarachnoid hemorrhage (SAH) is a secondary disease mainly caused by aneurysms
The lowest Glasgow Coma Scale (GCS) score improvement was only 0.7 in the thalamus group, which could be attributed to the important function of the thalamus

Summary

Introduction

Hemorrhagic stroke (HS) is usually treated under microscopy, but recently, an increasing number of cases have been treated under neuroendoscopy. The transcranial neuroendoscopic approach is feasible and safe for both PHS and SHS and is very effective for hematoma evacuation. ICH can be classified into primary and secondary ICH based on the etiology, while SAH is a secondary disease mainly caused by aneurysms. We classified HS patients into the primary HS (PHS) and secondary HS (SHS) groups, with the former comprising primary ICH cases and the latter comprising secondary ICH and SAH cases (Fig. 1). There has been a gradual increase in the number of cases treated by neuroendoscopy due to its advantages of excellent illumination, clear visualization, and multiangle views[6,7,8,9,10]. Satisfactory surgical and other outcomes were achieved in all cases in this study

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