Abstract
Thalamic hemorrhage bears the worst outcome among supratentorial intracerebral hemorrhage (ICH). Minimally invasive endoscopic-aided surgery (MIS) has been proved to be safe and effective in evacuating ICH. However, the ideal timing of MIS is still a controversy. In this study, we present our experience in the treatment of patients with thalamic hemorrhage by ultrarapid MIS evacuation. This retrospective analysis enrolled seven patients treated with ultrarapid MIS evacuation of thalamic hemorrhage. Seven patients treated with EVD with similar ICH score were included as match control. Primary endpoints included rebleeding, morbidity, and mortality. Hematoma evacuation rate was evaluated by comparing the pre- and postoperative computed tomography (CT) scans. Glasgow Outcome Scale Extended (GOSE) and modified Rankin Score (mRS) were noted at the 6-month and 1-year postoperative follow-up. Among the seven patients, six were accompanied with intraventricular hemorrhage. All patients received surgery within 6 hours after the onset of stroke. The mean hematoma volume was 35 mL, and the mean operative time was 116.4 minutes. The median hematoma evacuation rate was 74.9%. There was no rebleeding or death reported after the surgery. The median GOSE and mRS were 3 and 5, respectively, at 6 months postoperatively. Further, 1-year postoperative median GOSE and mRS were 3 and 5, respectively. The data suggest that the ultrarapid MIS technique is a safe and effective way in the management of selected cases with thalamic hemorrhage, with favorable long-term functional outcomes. However, a large, prospective, randomized-controlled trial is needed to confirm these findings.
Highlights
Spontaneous intracerebral hemorrhage (ICH) is a common neurosurgical emergency
We focus on the surgical management of thalamic hemorrhage and present our experience in treating thalamic hemorrhage using ultrarapid minimally invasive endoscopicaided surgery (MIS) evacuation by Behavioural Neurology comparing the postoperative outcomes between patients receiving ultrarapid MIS evacuation and patients using extraventricular drainage (EVD) without thalamic hematoma evacuation
Patients were excluded if they had met anyone of the following criteria: (1) ICH caused by the trauma, tumor, and coagulopathy; (2) with end-stage renal disease or Child-Pugh Class C cirrhosis; (3) taking antiplatelet or anticoagulation medications, (4) with preoperative Glasgow coma scale (GCS) score of 14; and (5) without the data on follow-up computed tomography (CT) result within 3 days or lost to follow-up at 6 months
Summary
Spontaneous intracerebral hemorrhage (ICH) is a common neurosurgical emergency. The incidence of ICH is around 24 per 100,000 person-years in white people, 23 per 100,000 person-years in black people, and 52 per 100,000 personyears in Asian people [1]. Thalamic hemorrhage bears the worst outcome among supratentorial ICH. Due to its deeply seated anatomy, thalamic hemorrhage is hard to evacuate. Minimally invasive endoscopicaided surgery (MIS) for evacuating ICH has been considered as a safe and effective approach, showing with lower morbidity and mortality than the traditional craniotomy [2,3,4]. Many factors such as hematoma volume, intraventricular extension, and location of hematoma have been found to be associated with the prognosis of MIS [5]. The ideal timing to perform minimally invasive surgery (MIS) is still a controversy. It has been reported that early surgery performed within 6 to 24 hours ICH is ideal for MIS [6]; whether the ultrarapid MIS performed within 6 hours after ICH is favorable to patients is still under debate
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