Supratentorial Hypertensive Intracerebral Hemorrhage Research Articles

Efficacy of robot‐assisted minimally invasive stereotactic puncture therapy for supratentorial hypertensive intracerebral hemorrhage

AbstractObjectiveTo evaluate the efficacy of robot‐assisted minimally invasive stereotactic puncture therapy (MISPT) for supratentorial hypertensive intracerebral hemorrhage (HICH).MethodsWe retrospectively analyzed 133 patients with supratentorial HICH treated using robot‐assisted MISPT (RM group; n = 77) or conventional craniotomy (CC group; n = 56). In our primary analysis, we evaluated the hematoma volume at discharge. In our secondary analyses, we evaluated the Glasgow Coma Scale (GCS) score at discharge; the operation time, intraparenchymal drainage catheter removal time, the length of hospital stay, and complications during hospitalization; the early and 6‐month postoperative mortality; and functional scores 6‐month postoperatively.ResultsThere were no statistical differences in the preoperative characteristics between the groups, such as age distribution (52.8 ± 9.6 vs. 55.3 ± 7.8 years), hematoma volume (38.4 ± 10.4 vs. 41.1 ± 11.0 mL), and GCS score (10.7 ± 2.2 vs. 9.8 ± 2.8). Hematoma volume at discharge did not significantly differ between the groups (2.6 ± 2.1 mL vs. 2.4 ± 2.1 mL). The GCS score at discharge was significantly higher in the RM group (13.5 ± 2.1 vs. 11.6 ± 3.1; p < .001). Operation time (40.3 ± 7.0 min vs. 143.1 ± 61.3 min;p < .001), intraparenchymal drainage catheter removal time (1.2 ± 0.4 vs. 2.1 ± 0.7 days; p < .001), and length of hospital stay (9.3 ± 2.7 vs. 11.1 ± 4.8 days; p = .013) were significantly shorter in the RM group. The incidence rates of pneumonia, gastrointestinal bleeding, and intracranial infection were significantly lower in the RM group. Although the incidence of rebleeding was lower in the RM group (1.3% vs. 5.4%), the difference was not significant. Six months after surgery, the Barthel Index, Glasgow Outcome Scale, and Karnofsky performance status scores were significantly higher, whereas the modified Rankin scale score was significantly lower in the RM group (p = .002, p = .007, p = .001, and p = .018, respectively). Two RM group patients (3.1%) and six CC group patients (12.2%) died between hospital discharge and 6 months after surgery (p = .127).ConclusionThe main advantages of robot‐assisted MISPT for supratentorial HICH were shown in minimally invasive, precision, and low incidences of complications. In addition, it may improve the prognosis significantly. Thus, it has great potential to be popularized and clinically applied in the future.

Comparing the results of surgical and conservative treatment of patients with supratentorial hypertensive intracerebral hemorrhage. A new look at previously known randomized studies

Hemorrhagic stroke is a medical and social problem, with an incidence of 15–35 per 100 000 people per year. It is characterized by high patient mortality (up to 53% in the first year) and disability, with most of the surviving patients having persistent neurological deficits and about 20% of them requiring continuous assistance. The advantages of surgical or conservative treatment of patients with supratentorial hypertensive intracerebral hemorrhage (ICH) are still under discussion. This literature review is based on 12 open-source articles on prospective randomized trials comparing conservative and surgical treatment results in patients with supratentorial ICH, which demonstrate contradictory results. Based on an analysis of all the works, we can conclude that surgical treatment has an advantage when performed early (within 12–72 hours) in patients whose level of consciousness is 9–12 points on the Glasgow Coma Scale. Needle aspiration and local fibrinolysis are effective for basal ganglia ICH, while open surgery and endoscopic aspiration are effective in subcortical ICH. For subcortical ICHs that are 20–80 cm 3 in size, surgical treatment improved functional outcomes, while in ICHs larger than 50 cm 3 , it helped to reduce mortality. For citation: Godkov I.M., Dashyan V.G. [Comparing the results of surgical and conservative treatment of patients with supratentorial hypertensive intracerebral hemorrhage. A new look at previously known randomized studies]. Annals of clinical and experimental neurology. 2021; 15(1): 71–79. (In Russ.) https://doi.org/10.25692/ACEN.2021.1.9

The whole nursing intervention in the early operation of the supratentorial hypertensive intracerebral hemorrhage

Objective By strengthening the whole nursing intervention in the early operation of supratentorial hypertensive cerebral hemorrhage, the prognosis of patients can be effectively improved. Methods From January 2013 to December 2017, 118 patients with supratentorial hypertensive intracerebral hemorrhage undergoing early operation were selected. Whole nursing intervention was carried out in 118 patients with hypertensive intracerebral hemorrhage who underwent early operation. The nursing effect of patients were analyzed. Results Among the 118 patients, 95 patients survived, with a survival rate of 80.51%, the Modified Rankin Scale (MRS) score (3.77±1.74)points, 26 patients recovered well, with a good rate of 22.03%, 19 patients with perioperative stress ulcer, 31 patients with intrapulmonary infection, 8 patients with intracranial infection, 3 patients with new atrial fibrillation, and 7 patients with heart failure. Conclusions Whole nursing intervention in early operation of hypertensive cerebral hemorrhage can effectively reduce the incidence of complications, improve the prognosis of patients, lift the quality of life of patients. Key words: Supratentorial hypertension; Cerebral hemorrhage; Whole nursing

Efficacy of neuroendoscopic surgery versus craniotomy for supratentorial hypertensive intracerebral hemorrhage: A meta-analysis of randomized controlled trials.

BackgroundHypertensive cerebral hemorrhage (HCH) is a potentially life‐threatening neurological condition with an extremely high morbidity and mortality. In recent years, neuroendoscopy has been used to treat intracerebral hemorrhage (ICH). However, the choice of neuroendoscopic surgery versus craniotomy for patients with intracerebral hemorrhages is controversial.AimWe conducted this meta‐analysis to assess the efficacy of neuroendoscopic surgery compared with craniotomy in patients with supratentorial hypertensive ICH.MethodsA systematic electronic search was conducted of online electronic databases: PubMed, Embase, and the Cochrane Library updated on December 2017. The meta‐analysis only included randomized controlled studies.ResultsThree randomized controlled trials met our inclusion criteria. The pooled analysis of death showed that neuroendoscopic surgery decreased the rate of death when compared with craniotomy (RR = 0.58, 95% CI 0.26–1.29; p = .18). The pooled result of complications indicated that neuroendoscopic surgery has a tendency toward lower complications (RR = 0.37, 95% CI 0.28–0.49; p < .001).ConclusionsOur results suggested that neuroendoscopic surgery has lower complications, but no superior advantages in morbidity rates. Since the advantage of neuroendoscopic surgery has been performed in some area, the continuation of multi‐center comparative investigation with craniotomy may be necessary. Moreover, some efforts need to be taken in selecting appropriate patients with different treatments.

Endoscopic Hematoma Evacuation for Intracerebral Hemorrhage Under Local Anesthesia: Factors That Affect the Hematoma Removal Rate

Recent advances in endoscopic surgery have led to more patients being able to undergo endoscopic removal of hypertensive intracerebral hemorrhage (HICH). However, because of the minimal invasiveness, endoscopic HICH removal through a narrow surgical window can result in a low removal rate. The goal of the present study was to investigate the factors that affect the removal rate of HICH evacuation. The data from 28 patients with supratentorial HICH who had undergone endoscopic hematoma evacuation were retrospectively analyzed. The inclusion criteria were spontaneous supratentorial HICH with a hematoma volume >30 mL, admission to the hospital within 24 hours of ictus, and a Glasgow coma scale score of ≥4. Of the 28 patients, 9 were women and 19 were men, ranging in age from 41 to 86 years (mean, 60.7 ± 12.7). The hematoma location was the basal ganglia in 25 patients and subcortical in 3 patients. The mean preoperative hematoma volume was 62.4 ± 22.5 mL. The hematoma removal rate was <60% for 11 patients (poor evacuation group) and ≥60% for in 17 patients (good evacuation group). Comparing the 2 groups, chronic renal failure treated with hemodialysis (P= 0.0072, χ2 test), liver cirrhosis (P=0.023, χ2 test), and surgeon experience with ≥10 cases of endoscopic HICH removal (P= 0.016, χ2 test) were significant factors related to the HICH removal rate. To achieve a good removal rate, surgeons should have experience performing the endoscopic procedure. Also, patients with end-stage chronic renal failure or liver cirrhosis should be excluded.

Erratum. Effectiveness of endoscopic surgery for supratentorial hypertensive intracerebral hemorrhage: a comparison with craniotomy.

Erratum. Effectiveness of endoscopic surgery for supratentorial hypertensive intracerebral hemorrhage: a comparison with craniotomy.

Hemispheric differences in blood pressures of patients with putaminal and thalamic hemorrhages

Our assumption that blood pressure (BP) in supratentorial hypertensive intracerebral hemorrhage patients does not differ significantly according to the hemispheric laterality has never been verified before. This study was carried out to explore the possibility of hemispheric BP differences and whether this might influence the outcomes. A review of the charts/radiographic images of 281 patients with putaminal/thalamic hemorrhages diagnosed within 6 h of symptom onset was performed. Immediately after arrival, they received a continuous intravenous nicardipine infusion to lower and maintain systolic BP (SBP) between 120 and 160 mmHg. They were quadrichotomized as follows: left putamen (LP, n=89), right putamen (RP, n=69), left thalamus (LT, n=68), and right thalamus (RT, n=55). Two-group or four-group comparisons were made on demographic variables, BPs, and outcomes. Patients with left-sided hemorrhages presented with significantly worse neurologic scores in both hemorrhage categories and tended to sustain larger hematomas than their right-sided counterparts. Significant differences in SBPs between LP and RP (205 ± 31 vs. 189 ± 29 mmHg, P<0.01) as well as in diastolic BPs between LT and RT (109 ± 19 vs. 97 ± 20 mmHg, P=0.03) were noted. Multivariate regression analysis showed that patients with SBPs of at least 220 mmHg were 2.9 times more likely to harbor left-sided hemorrhages. There were no significant intergroup differences in responsiveness to a continuous intravenous nicardipine infusion or 30-day mortality rates. Although the differences in BPs are unlikely to have influenced outcomes, future trials involving supratentorial hypertensive intracerebral hemorrhages may benefit from considering hemispheric differences in BP and other demographic variables.