Open and minimally invasive surgery for hypertensive intracranial hemorrhages. Surgey outcomes of 500 patients

Abstract

The objective of the research: to compare the outcomes of three surgical methods used in a large cohort of patients with hemorrhagic stroke.Materials and methods. We performed a retrospective analysis of surgery outcomes in 500 patients with hypertensive intracranial hemorrhages (ICHs) operated on in N.V. Sklifosovskiy Research Institute of Emergency Medicine between 1997 and 2020. Mean patients’ age was 53.1 ± 12.2 years. The sample included 335 men (67 %) and 165 women (33 %). Mean time to surgery was 3.3 ± 2.6 days. More than half of the patients underwent open surgeries (n = 271; 54.2 %); 98 patients (19.6 %) had puncture aspiration and local fibrinolysis of intracranial hemorrhages; 131 patients (26.2 %) had endoscopic aspiration. Radicality of ICH removal was evaluated using brain computed tomography performed within 24 h postoperatively. Outcomes were assessed 30 days postoperatively using the Modified Rankin Scale (mRS).Results. Open surgery had the highest radicality (94.0 % [range: 79 %; 100 %]), whereas the radicality of endoscopic aspiration and puncture aspiration with local fibrinolysis was 80.0 % [range: 58 %;95 %] and 72.0 % [range: 58 %; 84 %], respectively (K.-W. = 52.7, p < 0.0001). The highest ICH recurrence rate (27.6 %) was observed after puncture aspiration and local fibrinolysis. Endoscopic aspiration and open surgery resulted in relapses in 16.8 % and 9.2 % of individuals, respectively (χ2 = 19.7, p = 0.00005). The mRS outcomes were as follows: type 0 in 84 patients (16.8 %); type 1 in 37 patients (7.4 %); type 2 in 46 patients (9.2 %); type 3 in 38 patients (7.6 %); type 4 in 43 patients (8.6 %); type 5 in 142 patients (28.4 %); type 6 in 110 patients (22.0 %). The outcomes depended on ICH location and surgical method. Patients with lobar ICHs had better outcomes after open surgery, while patients with lateral and cerebellar ICH had better outcomes after puncture aspiration, local fibrinolysis, and endoscopic aspiration (χ2 = 8.1, p < 0.02).Conclusion. Each surgical technique (open surgery, puncture aspiration, local fibrinolysis, and endoscopic aspiration) has its advantages and disadvantages depending on ICH location. Open surgery ensured better outcomes in patients with lobar ICHs, while individuals with deep ICH and cerebellar ICH demonstrated better outcomes after puncture aspiration, local fibrinolysis, and endoscopic aspiration.