Treatment Of Hypertensive Intracerebral Hemorrhage Research Articles

Systematic review and Meta-analysis on efficacy and safety of Naoxueshu Oral Liquid in treatment of hypertensive intracerebral hemorrhage

To systematically review the efficacy and safety of Naoxueshu Oral Liquid in treatment of hypertensive intracerebral hemorrhage, four Chinese databases, four English databases, clinical trials registration center(ClinicalTrials.gov) and Chinese clinical trial registry were retrieved. The retrieval time was from the establishment of each database to September 9, 2020. According to the set criteria, the randomized controlled trial(RCT) of Naoxueshu Oral Liquid combined with conventional Western medicine was selected. The "Cochrane bias risk assessment" tool was used to evaluate the quality of the included studies. RevMan 5.4.1 was used to conduct Meta-analysis of the included studies and GRADE system was used to evaluate the evidence quality of the outcome indicators. Eleven studies were finally included, with a total sample size of 1 221 cases, 612 cases in the treatment group and 609 cases in the control group. Meta-analysis showed that Naoxueshu Oral Liquid combined with conventional Western medicine had no significant difference compare with conventional Western medicine in reducing National Institute of health stroke scale(NIHSS) after 2 weeks of treatment for hypertensive intracerebral hemorrhage(MD=-1.59,95%CI[-3.46,0.29],P=0.10), but was superior to conventional Western medicine after 30 d of treatment(MD=-1.16,95%CI [-1.39,-0.94],P<0.000 01). Naoxueshu Oral Liquid combined with conventional Western medicine was superior to conventional Western medicine in improving Glasgow coma scale(MD=1.00,95%CI[0,2.00],P=0.05) and reducing the incidence of secondary brain insults(RR=0.38,95%CI[0.24,0.59],P<0.000 1), but there was no significant difference in increasing Barthel index(MD=1.00,95%CI[-0.30,2.30],P=0.13). In terms of effective rate, studies using Guideline for clinical trials of new patent Chinese medicines, NHISS or Glasgow outcome scale(GOS) had shown that Naoxueshu Oral Liquid combined with conventional Western medicine was superior to conventional Western medicine(RR_(Guideline for clinical trials of new patent Chinese medicines)=1.27,95%CI[1.10,1.46],P=0.001;RR_(NHISS)=1.26,95%CI[1.13,1.40],P<0.000 1;RR_(GOS)=1.54,95%CI[1.22,1.93],P=0.000 2). In reduction of hematoma volume, Naoxueshu Oral Liquid combined with conventional Western medicine was superior to conventional Western medicine after 2 and 4 weeks of treatment(MD_(2 week)=-2.31,95%CI[-3.12,-1.49],P<0.000 01;MD_(4 week)=-2.04,95%CI[-2.41,-1.68],P<0.000 01). GRADE system showed that the evidence level of the above outcome indicators was low and extremely low. In terms of adverse reactions, two of the included studies reported mild adverse reactions, and the rest of studies were not mentioned, so this study was not able to make a positive evaluation of the safety of Naoxueshu Oral Liquid. This study showed that compared with conventional Western medicine, combined Naoxueshu Oral Liquid may be better for hypertensive intracerebral hemorrhage. However, due to the high bias risk in the included studies, more large-sample and high-quality RCTs are still needed in the future.

Efficacy and safety of intraoperative ultrasound-assisted neuroendoscopy in the treatment of hypertensive intracerebral hemorrhage via transsylvian approach

Objective: To explore the efficacy and safety of intraoperative ultrasound-assisted neuroendoscopy for treating hypertensive intracerebral hemorrhage (HICH) via lateral fissure and insula approach. Methods: The clinical data of 66 patients with HICH in basal ganglia who underwent intraoperative ultrasound-assisted neuroendoscopy via lateral fissure and insula approach for hematoma evacuation were retrospectively analyzed, including operative data and follow-up results. All patients had no brain hernia before operation. The hematoma was located by the ultrasound and then the path into the hematoma cavity was determined. Meanwhile, the residual hematoma was also detected by using the ultrasound. The clearance rate of hematoma was observed by CT. Barthel index was used to evaluate the activity of daily living. Results: The amount of residual hematoma was less than 10% in 63 ases and 10%-20% in 3 cases. There were 11 cases of postoperative pneumonia, of whom 9 cases underwent percutaneous tracheotomy. Rebleeding occurred in 2 cases, but the amount was small, and there was no need for reoperation. Meanwhile, there was 1 case of secondary intracranial infection and 1 case of secondary hydrocephalus. No case of cerebral contusion was reported. Half a year after the operation, Barthel Index grading showed that there were 3 cases of grade I, 25 cases of grade Ⅱ, 34 cases of grade Ⅲ, 3 cases of grade Ⅳ and 1 case of death, respectively. Conclusions: Intraoperative ultrasound-assisted neuroendoscopy via lateral fissure and insula approach can improve the efficacy and safety of treatment for HICH.

Advantages of Small Bone-Window Craniotomy Under Microscope Combined Postoperative Intracranial Pressure Monitoring in the Treatment of Hypertensive Intracerebral Hemorrhage.

The aim of this study is to analyze the clinical effect of small bone-window craniotomy with microscope combined postoperative ICP monitoring, and further explore an appropriate treatment for HICH patients. One hundred fifty patients with HICH were selected according to inclusion and exclusion criteria and divided into 3 groups at random, 50 each group. Patients in 3 groups were treated with conventional craniotomy, small bone-window craniotomy and small bone-window craniotomy combined ICP monitoring respectively. The surgical efficiency, treatment effect and outcomes were recorded and analyzed. The intraoperative blood loss and operation time of small window groups were significantly less than that of conventional group, and the hematoma clearance rate in small window groups were significantly higher than in conventional group (P < 0.05). Compared with conventional group, the hospital stays and mannitol dose used were less in small window groups and least in small window combined ICP monitoring group (P < 0.05). The complication rate in small window combined ICP monitoring group was 10%, which was significantly lower than in conventional group (26%, P < 0.05), while no significant difference was found between small window group (18%) compared with the other 2 groups respectively (P > 0.05). The difference of morality rate between 3 groups wasn't significant (P > 0.05). Three treatment significantly increased the Barthel index score, and the improvement of small window combined ICP monitoring group was significantly higher than in other 2 groups respectively (P < 0.05), while the difference between this two groups wasn't significant (P > 0.05). Small bone-window craniotomy is more efficient and convenient than conventional craniotomy in the treatment of HICH. In the meantime, small bone-window craniotomy simultaneous with ICP monitoring significantly improved clinical effect and treatment outcomes of HICH patients.

Observation of curative effect of soft channel minimally invasive treatment for hypertensive intracerebral hemorrhage and its influence on serum IL-18, VEGF, CRP and TNF-α in patients with hypertensive intracerebral hemorrhage

Objective To investigate the effect of soft channel minimally invasive treatment on hypertensive intracerebral hemorrhage (HICH) and its influence on serum interleukin-18 (IL-18), vascular endothelial growth factor (VEGF), C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α). Methods From April 2017 to April 2019, 82 patients with HICH admitted to Taizhou Hospital of Traditional Chinese Medicine were randomly divided into observation group (41 cases) and control group (41 cases) according to random number table method.The control group was treated with hard channel minimally invasive treatment, while the observation group was treated with soft channel minimally invasive treatment.The therapeutic effect, intracranial hematoma volume, serum levels of IL-18, VEGF, CRP and TNF-α before and 7 days after operation, neurological deficit degree (NIHSS) scores before and 3 months after operation, and complications after operation were compared between the two groups. Results The total effective rate of the observation group (92.68%) was higher than that of the control group (70.73%) (χ2=6.609, P<0.05). The amount of intracranial hematoma in the observation group [(4.03±1.10)mL] was lower than that in the control group [(7.17±1.36)mL] (t=11.495, P<0.05). At 7 d after operation, the serum levels of IL-18[(123.74±10.27)ng/L], VEGF[(113.28±12.10)ng/L], CRP[(17.83±3.20)mg/L] and TNF-α[(0.65±0.12)ng/L] in the observation group were lower than those in the control group [(150.38±13.21)ng/L, (141.63±16.87)ng/L, (29.96±4.53)mg/L and (1.09±0.17)ng/L] (t=11.638, 9.101, 13.831, 5.569, all P<0.05). The NIHSS score of the observation group[(16.53±3.19)points] was lower than that of the control group[(23.43±4.65)points] at 3 months after operation (t=7.824, P<0.05). The incidence of complications in the observation group (12.20%) was lower than that in the control group (34.15%) (χ2=5.549, P<0.05). Conclusion Soft channel minimally invasive treatment for HICH has good effect and can reduce the changes of serum levels of IL-18, VEGF, CRP and TNF-α. Key words: Intracranial hemorrhage, hypertensive; Surgical procedures, minimally invasive; Soft channel minimally invasive; Hard channel minimally invasive; Interleukin-18; Vascular endothelial growth factor; C-reactive protein; Tumor necrosis factor-α

Comparison of curative effects of minimally invasive surgery and conservative treatment for hypertensive intracerebral hemorrhage

Objective To compare the clinical effect of minimally invasive operation and conservative treatment on hypertensive intracerebral hemorrhage. Methods From January 2015 to January 2018, 85 patients with hypertensive intracerebral hemorrhagein in Gujiao Mining Area General Hospital of Xishan Coal and Electricity Group were selected.According to the treatment methods, the patients were divided into two groups: the minimally invasive operation group(n=46) and the conservative treatment group(n=39). The minimally invasive operation group was treated with minimally invasive surgery, and the conservative treatment group was treated with the conservative therapy of neurology.The clinical efficacy and hospital stay of the two groups were compared.The incidence of complications, neurological impairment score, ADL score and prognosis of the teo groups were compared. Results The total effective rate of the minimally invasive surgery group was 95.65%, which was higher than 79.49% of the conservative treatment group(χ2=5.586, P<0.05). The length of hospitalization in the minimally invasive surgery group was (8.52±2.31)d, which was significantly shorter than (11.79±3.05)d in the control group (t=5.617, P<0.05). The incidence rate of complication of the minimally invasive surgery group was 6.52%, which was lower than 25.64% of the conservative treatment group(χ2=5.955, P<0.05). After treatment, the nerve function defect score of the two groups was significantly reduced (t=9.455, 16.773, all P<0.05), the daily life ability score was significantly increased (t=8.372, 14.085, all P<0.05), which in the invasive surgery group were better than those in the conservative treatment group(t=6.974, 5.063, all P<0.05). The good prognosis rate of the minimally invasive surgery group was 67.39%(31/46), which was significantly higher than 43.59%(17/39) of the conservative treatment group (χ2=4.864, P<0.05). Conclusion Minimally invasive surgery is superior to conservative treatment in the treatment of hypertensive intracerebral hemorrhage. Key words: Cerebral hemorrhage; Hypertension; Surgical procedures, minimally invasive; Controlled clinical trial

Different Techniques of Minimally Invasive Craniopuncture for the Treatment of Hypertensive Intracerebral Hemorrhage

Efficacy of minimally invasive craniopuncture with the YL-1 puncture needle (hard-channel) and soft drainage tube (soft-channel) in treating hypertensive intracerebral hemorrhage (HICH). A total of 150 patients with HICH were randomly assigned into 3 groups: conservative group (n= 50), hard-channel group (n= 50), and soft-channel group (n= 50). Computed tomography, National Institutes of Health Stroke Scale (NIHSS) and the levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), superoxide dismutase (SOD), and malondialdehyde (MDA) in serum and in drainage fluid were examined on days 2, 4, and 6 after operation. Compared with the conservative group, the serum levels of IL-6, TNF-α, and MDA were decreased and SOD was increased (P < 0.05); volumes of hematoma and perihematomal edema as well as NIHSS were reduced (P < 0.05) in minimally invasive groups on days 7, 14, and 28 after operation. Compared with the hard-channel group, the serum levels of IL-6, TNF-α, MDA, and SOD showed the same trend as above in the soft-channel group. In the soft-channel group, MDA was reduced and SOD was increased in brain drainage fluid on days 2, 4, and 6 (P < 0.05); volumes of hematoma and perihematomal edema on days 14 and 28 were found to be reduced compared with the hard-channel group (P < 0.05). There was no significant difference of volumes of hematoma and perihematomal edema on day 7 between minimally invasive groups. NIHSS of the soft-channel group appeared to be significantly reduced on days 7, 14, and 28 after operation (P < 0.05). Soft-channel minimally invasive craniopuncture is an ideal technique for treating HICH, with advantages of alleviating cerebral edema, reducing oxidative stress, and inhibiting inflammatory response.

Stereotactic treatment of hypertensive intracerebral hemorrhage in basal ganglia region

Objective To evaluate the efficacy of stereotactic hematoma evacuation surgery for hypertensive cerebral hemorrhage in basal ganglia region. Methods A retrospective analysis was performed on 65 cases of hypertensive cerebral hemorrhage in the basal ganglia from August 2015 to March 2018 at the Stereotactic and Neurofunctional Center of the 306th Hospital of PLA. According to different surgical methods, those patients were divided into 2 groups. In the hematoma puncture group, 35 patients underwent hematoma puncture and drainage surgery; in the stereotaxis group, 30 patients underwent stereotactic puncture and catheter drainage surgery assisted by robot Remebot. The baseline conditions, bleeding time, volume of hematoma, preoperative GCS (Glasgow coma scale) score, Barthel score before discharge and at 3 months post operation, and the time of thorough hematoma drainage were compared between the 2 groups. Results (1) The time for thorough hematoma drainage in the stereotaxis group was significantly less than that in the hematoma puncture group. There was a significant difference between the 2 groups (Z=3.69, P<0.01). (2) Barthel scores before discharge (89.7±7.2) and at 3 months post operation (94.0±5.7) in stereotaxis group were significantly higher than those in hematoma puncture group (before discharge: 75.3±7.2, 3 months post operation: 76.4±8.2, both P<0.01). Conclusion Stereotactic hematoma evacuation surgery could significantly accelerate the removal time of hematoma in patients with hypertensive intracerebral hemorrhage, quickly relieve the compression of brain tissue by hematoma and promote the recovery of neurological function. Key words: Intracranial hemorrhage, hypertensive; Basal ganglia; Neurosurgical procedures; Stereotactic; Treatment outcome

The cytological mechanism and effects of hypertensive cerebral hemorrhage treatment by citicoline on serum GFAP and copeptin level

In this study, 102 patients with hypertensive intracerebral hemorrhage (52 patients in the citicoline treatment group and 50 patients in the routine treatment group) were analyzed and compared. It was found that citicoline-assisted treatment of hypertensive intracerebral hemorrhage could inhibit the release of serum glial fibrillary acidic protein (GFAP) and peptides ( P &lt; 0.05) and improve the prognosis and neurological and daily living ability of patients ( P &lt; 0.05). In addition, CDP-choline reduced the mortality of neurons, inhibited inflammatory factors, and improved the prognosis of patients ( P &lt; 0.05). A high dose of CDP-choline was also significantly effective in protecting neurons.

Surgical treatment of hypertensive intracerebral hemorrhage

Surgical treatment of hypertensive intracerebral hemorrhage

Efficacy and safety of minimal invasive surgery treatment in hypertensive intracerebral hemorrhage: a systematic review and meta-analysis

BackgroundRecently, minimal invasive surgery (MIS) has been applied as a common therapeutic approach for treatment of hypertensive intracerebral hemorrhage (HICH). However, the efficacy and safety of MIS is still controversial compared with conservative medical treatment or conventional craniotomy. This meta-analysis aimed to systematically assess the safety and efficacy of MIS compared with conservative method and craniotomy in treating HICH patients.MethodsPubMed, Embase, Web of Science, and Cochrane Controlled Trials Register were used to identify relevant studies on MIS treatment of HICH up to November 2017. This study evaluated Glasgow Outcome Scale (GOS) score, Activities of Daily Living (ADL) score, pulmonary infection rate, mortality rate, and rebleeding rate for patients who underwent MIS, or conservative method, or craniotomy. Subgroup analyses were performed to compare randomization versus non-randomization and large hematoma versus small or mild hematoma. Begg’s test and Egger’s test were used to determine the potential presence of publication bias.ResultsSixteen studies consisting of 1912 patients were included in this study to compare the efficacy and safety of MIS to conservative method or craniotomy. MIS contributed to a significant improvement on the prognosis of the patients comparing with conservative group or craniotomy group. Patients undergoing MIS had a lower mortality rate when compared to those receiving conservative method. Also, MIS led to a notable reduction of rebleeding rate and an effective improvement of the patient’s quality of life by contrast with craniotomy. No obvious difference was found in terms of the pulmonary infection rate among the comparisons of three treatment methods. Randomization is not the potential source of heterogeneity, but hematoma volume may be a risk factor for post-operative mortality rate. No statistical evidence of publication bias among studies was found under most of comparison models.ConclusionThis meta-analysis suggests that minimal invasive surgery is an efficient and safe method for the treatment of hypertensive intracerebral hemorrhage, which is associated with a low mortality rate and rebleeding rate, as well as a significant improvement of the prognosis and the quality life of patients when compared with conservative medical treatment or craniotomy.

Comparative study of surgical treatment of hypertensive intracerebral hemorrhage assisted with ROSA system and stereotactic frame

Objective To compare the surgical outcome of intracerebral hematoma drilling and drainage for hypertensive intracerebral hemorrhage (HICH) using robotized stereotactic assistant(ROSA)-assisted and stereotactic framework. Methods A retrospective study was conducted on 368 patients with HICH who underwent hematoma drilling at Department of Neurosurgery, General Hospital of Shenyang Military Command from March 2015 to April 2017. According to the surgical method, all cases were divided into the stereotactic frame group (group A) and ROSA group (group B). Comparison was conducted on the treatment outcome of those 2 surgical methods for HICH. Results There was no statistically significant difference in gender, age, preoperative GCS (Glasgow coma scale), time interval from bleeding to operation and bleeding volume between 2 groups (all P>0.05). The operating time (27.3±8.4 min) and incidence of rebleeding (1.7%, 3/172) were lower in group B than those in group A [operation time: (44.2±7.7) min, incidence of rebleeding: 8.7% (17/196)] (both P<0.01). In group A, 12 (6.1%) patients developed postoperative intracranial infection and none had intracranial infection in group B and there was statistically significant difference between the 2 groups (P=0.001). The extubation time in groups A and B was (2.5±0.7) days and (1.2±0.5) days post opeartion, respectively, which were significantly different (P<0.001). The 30-day mortality rate in group B (2.3%, 4/172) was lower than that in group A (9.2%, 18/196) (P=0.006). Conclusion Compared with stereotactic frame-assisted surgery, ROSA-assisted operation seems to be associated with shorter operation duration, earlier extubation time, and lower incidence of postoperative rebleeding, intracranial infection and 30-day mortality rate for HICH patients, which is thus worthy of clinical promotion. Key words: Intracranial hemorrhage, hypertensive; Neurosurgical procedures; Treatment outcome; Robotized stereotactic assistant; Stereotactic frame

Effect analysis of neuroendoscopy combined with neuronavigation in the treatment of hypertensive intracerebral hemorrhage

Objective To investigate the efficacy of neuroendoscopy combined with neuronavigation in the treatment of hypertensive intracerebral hemorrhage (HICH). Methods A retrospective analysis was conducted on 96 patients with HICH who underwent treatment at Department of Neurosurgery, the Affiliated Dalian Central Hospital of Dalian Medical University from January 2015 to January 2017. All cases were divided into endoscopic navigation group (n=44) and microscopy group (n=51) based on the treatment method. The endpoints including hematoma clearance rate, intraoperative blood loss, operation time, postoperative hospitalization and hospitalization expenses were analyzed and compared between the 2 groups. The Glasgow outcome scale (GOS) was used for assessment at a 6-month follow-up. Results Hematoma clearance rate in endoscopic navigation group was higher than that in microscopy group (91.5±6.0 % vs. 83.7±6.8 %, P<0.001), while intraoperative blood loss(74.1±14.0 ml vs. 224.9±32.6 ml), operation time(69.6±13.7 min vs.128.2±28.4 min), postoperative hospitalization(12.4±2.8 d vs.18.3±2.4 d), and hospitalization expenses(38 600±9 600 yuan vs. 52 300±11 200 yuan) in endoscopic navigation group were significantly lower than those in microscopy group (all P<0.001). At the 6-month follow-up, the score of GOS in endoscopic navigation group was significantly better than that in microscopy group (P=0.029). Conclusion Treatment of HICH using neuroendoscopy combined with neuronavigation seems to be featured with less trauma, good efficacy, good prognosis and low costs, which is thus worth being applied and promoted in clinical practice. Key words: Natural orifice endoscopic surgery; Intracranial hemorrhage, hypertensive; Neurosurgical procedures; Neuronavigation; Treatment outcome

Comparison of effectiveness between two different modes of surgical intervention for the treatment of intracerebral hemorrhage in hypertensive patients

Objective To study the efficacy of two different modes of surgical intervention for the treatment of hypertensive intracerebral hemorrhage (HICH): YL-1 type hematoma removed by needle aspiration plus bio-enzyme liquefaction versus conventional craniectomy plus hematoma evacuation. Methods Medical records of 23 patients with HICH treated from December 2012 to February 2017 were retrospectively analyzed. The differences in demographics, length of operation time, costs and length of hospital stay, Glasgow Outcome Scale scores and 3-month follow-up results were compared between the YL-1 type hematoma removed by needle aspiration plus bio-enzyme liquefaction in 12 patients and conventional craniectomy plus hematoma evacuation in 11 patients. Results There were no significant differences in the gender (male 58.33% vs. 63.64%, femal 41.67% vs. 36.36%) , age (65.5±11.8 years vs. 56.8±10.1 years), preoperative GCS (6.83±3.93 vs. 5.82±3.40), intracranial hematoma volume (50.52±23.07 mL vs. 68.77±11.18 mL) and length of hospital stay (15.58±14.72 days vs. 22.45±18.37 days) (P>0.05); There were statistically significant differences in length of operation time (0.73±0.21 h vs. 3.92±0.67 h) and hospitalization costs (45 230.50±36 566.88 yuan of RMB vs. 79 857.90±34 916.48 yuan of RMB) between two groups (P 0.05). Conclusions The minimally invasive YL-1 type hematoma aspiration procedure with bio-enzyme liquefaction as a minimally invasive surgery may be superior to conventional craniectomy for treating HICH because it can offer shorter operation time, more accurate hematoma localization, lower risk of injury, and lower hospitalization costs. In particular, the procedure is suitable for elderly, frail, and poor general condition patients. It can also be applied as emergency treatment for HICH. Key words: Hypertensive intracerebral hemorrhage; Decompressive craniectomy; Minimally invasive surgery; YL -1 intracranial hematoma puncture needle therapy; Bio-enzyme liquefaction; Urokinase; Hematoma localization; Rehemorrhage

Effect of mild hypothermia on expression of inflammatory factors in surrounding tissue after minimally invasive hematoma evacuation in the treatment of hypertensive intracerebral hemorrhage.

Mild hypothermia combined with minimally invasive hematoma evacuation was evaluated in the treatment of hypertensive intracerebral hemorrhage to reduce inflammatory response of brain tissue around hematoma and ameliorate brain function, and to investigate its safety, effectiveness and feasibility. A total of 206 patients with acute spontaneous hypertensive intracerebral hemorrhage were collected clinically and randomly divided into minimally invasive hematoma evacuation group (group A) and mild hypothermia combined with minimally invasive hematoma evacuation (group B). The National Institutes of Health Stroke Scale (NIHSS) score was used before and after treatment. Group A was treated with minimally invasive intracranial hematoma evacuation using intracranial hematoma grinding puncture needle while group B received whole body water circulation type cooling blanket plus local cerebral mild hypothermia therapy with ice cap on the basis of minimally invasive surgery. Patients brain tissue fragments around hematoma taken out with rinsing during operation and at postoperative 1, 3 and 7 days were investigated. The contents of tumor necrosis factor-α (TNF-α) in serum at postoperative 1, 3 and 7 days were evaluated by enzyme-linked immunosorbent assay (ELISA). For the degree of nerve function defect of patients in the two groups, NIHSS score was lower in group B than that in group A at days 3 and 7, and the differences were statistically significant (P<0.05). The serum TNF-α content and expression of nuclear factor-κB (NF-κB) in brain tissue around hematoma reached the peak on the 3rd day. The TNF-α content and NF-κB expression were lower in group B than those in group A at each time-point (P<0.05). Mild hypothermia combined with minimally invasive hematoma evacuation can reduce the damage of hematoma to the surrounding brain tissue, effectively alleviate inflammatory response and decrease brain tissue injury, thus ameliorating brain function.

Comparison and analysis of the efficacy and safety of minimally invasive surgery and craniotomy in the treatment of hypertensive intracerebral hemorrhage.

Objective:This study was aimed to compare and analyze the effects and safety of minimally invasive and craniotomy in the treatment of hypertensive intracerebral hemorrhage.Methods:A total of 130 patients with hypertensive intracerebral hemorrhage were recruited. The patients were randomly divided into two groups (research and control group). Research group was treated with endoscopic minimally invasive surgery, while control group was treated with craniotomy and hematoma clearance. The basic situation, clinical effects, prognosis, nerve function and inflammatory factors of the two groups were compared while the condition of postoperative complications was also observed.Results:The operative time of patients in research group showed statistically significant (P<0.05) difference when compared with control group. Hematoma clearance rate and intraoperative blood loss of research group was significantly better than control group. There was no significant difference (P>0.05) between the two groups in preoperative hemorrhage and edema around the hematoma, however hemorrhage and edema around the hematoma after four weeks of surgery in the research group was significantly (P<0.05) lower than control group. After four weeks of treatment, the BI and SSS score, SP and IL-2 level of the research group were significantly higher than control group (P<0.05), while MRS score, IL-6, hs-CRP, TNF-α and SF was significantly lower than control group (P<0.05).Conclusion:Compared with craniotomy, minimally invasive surgery is more effective in the treatment of hypertensive intracerebral hemorrhage, as well as it is more conducive to restore neurological function, improve prognosis and reduce serum inflammatory factor levels.

Effect of antihypertensive agents ACEI/ARB and CCB on hypertensive intracerebral hemorrhage and inflammatory cytokines, serum ferritin, and serum P

The aim of this study was to investigate the effect of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB) and calcium channel blocker (CCB) antihypertensive drugs on the treatment of hypertensive intracerebral hemorrhage (ICH) and on the expression level of inflammatory factors, serum ferritin (SF), and serum substance P (SP). A total of 160 patients with hypertensive ICH were divided into three groups according to the type of antihypertensive drugs taken before cerebral hemorrhage: group A (40 cases, taking ACEI/ARB antihypertensive drugs before cerebral hemorrhage), group B (40 cases, CCB antihypertensive drugs were regularly taken before the onset of cerebral hemorrhage), and C group (80 cases, nor any antihypertensive drugs were regularly taken before the onset of cerebral hemorrhage). Patients in group C were further divided into two groups: group D (40 cases, ARB antihypertensive drugs were regularly taken after cerebral hemorrhage) and group E (40 cases, CCB antihypertensive drugs were regularly taken after cerebral hemorrhage). On the third day, after the onset of disease, the level of serum interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, SF, and SP in all the patients was detected. At the same time, the brain computed tomography (CT) was used to evaluate the cerebral edema. On the first day and the thirty day after the onset of disease, the patient’s neurological deficit status was assessed according to the National Institutes of Health Stroke Scale (NIHSS) score. On the third day after onset, the levels of IL-1β, IL-6, TNF-α, SF, and the volume of cerebral edema in group A and group B were significantly lower than those in group C ( P &lt; 0.05). The level of serum SP in group A and group B was significantly higher than that in group C ( P &lt; 0.05). However, there was no significant difference between group A and group B ( P &gt; 0.05). On the third day after onset, the mortality of each group is of no significant difference ( P &gt; 0.05). However, NIHSS scores in group A and group B were significantly lower than those in group C ( P &lt; 0.05). There was no statistical difference in NIHSS scores between group A and group B ( P &gt; 0.05). In conclusion, in the early stage of hypertensive ICH, early normative use of ACEI/ARB or CCB antihypertensive drugs can improve the prognosis of patients, whose mechanism may be related to the improvement of level of serum inflammatory factors and SP and SF.

Endoscopic treatment of hypertensive intracerebral hemorrhage: A technical review

Hypertensive intracerebral hemorrhage (ICH) is still a highlighting global issue. Endoscopic evacuation as a minimally invasive treatment became an alternative other than conventional craniotomy and catheter drainage for ICH. However, there is no unified indication or standardized procedure on endoscopic treatment of ICH. Here we explored the literature and gathered information from different studies, to review the background, technical points, and existing problems of endoscopic treatment for ICH.

Activating blood circulation to remove stasis treatment of hypertensive intracerebral hemorrhage: A multi-center prospective randomized open-label blinded-endpoint trial.

To investigate the efficacy and safety of the Chinese herbal therapeutic regimen of activating blood circulation (TRABC) in treatment of hypertensive intracerebral hemorrhage (HICH). This was a multi-center prospective randomized open-label blinded-endpoint (PROBE) trial with HICH admitted to 12 hospitals. Totally 240 participants were randomized to the treatment group treated with TRABC in addition to conventional Western treatment or the control group with conventional Western treatment equally for 3 months. Primary outcome was degree of disability as measured by modified Rankin Scale (mRS). Secondary outcomes were the absorption of hematoma and edema, National Institutes of Health Stroke Scale (NIHSS) scores and patient-reported outcome measures for stroke and Barthel activities of daily living index. Adverse events and mortality were also recorded. After 3 months of treatment, the rate of mRS 0-1 and mRS 0-2 in the treatment group was 72.5% and 80.4%, respectively, and in the control group 48.1% and 63.9%, respectively, with a significant difference between groups (P<0.01). Hematoma volume decreased significantly at day 7 of treatment in the treatment group than the control group (P=0.038). Average Barthel scores in the treatment group after treatment was 89.11±19.93, and in the control group 82.18±24.02 (P=0.003). NIHSS scores of the two groups after treatment decreased significantly compared with before treatment (P=0.001). Patient-reported outcomes in the treatment group were lower than the control group at day 21 and 3 months of treatment (P<0.05). There were 4 deaths, 2 in each group, and 11 adverse events, 6 in the treatment group and 5 in the control group. The integrative therapy combined TRABC with conventional Western treatment for HICH could promote hematoma absorption thus minimize neurologic impairment, without increasing intracerebral hematoma expansion and re-bleeding.

Comparison study of neuroendoscopic surgery and craniotomy in management of hypertensive intracerebral hemorrhage

Objective To investigate the therapeutic effects of neuroendoscopic surgery and craniotomy in the treatment of hypertensive intracerebral hemorrhage(HIH). Methods A total of 54 patients with hypertensive intracerebral hemorrhage treated by operation between May 2011 and June 2013 were analyzed retrospectively, 28 patients in neuroendoscopy group and 26 patients in craniotomy group.All patients were followed up for 3 months, two groups were estimated by the ADL scores, grade 1-3 of ADL was regarded as good prognosis, grade 4-5 of ADL and dead cases as poor prognosis. Results One death case in the neuroendoscopy group and 2 death cases in the craniotomy group, no statistical difference (P>0.05). The good prognosis rate of ADL was 82.1% (23/28) in the neuroendoscopy group and 53.9% (14/26) in the craniotomy group, the therapeutic effects of neuroendoscopy group were better than those of craniotomy group(P>0.05). Conclusion Neuroendoscopic surgery is a kind of method with little injury、favorable recovery of neural function in the treatment of hypertensive intracerebral hemorrhage. Key words: Hypertensive intracerebral hemorrhage; Neuroendoscope; Craniotomy

Effect of aescine sodium combined with albumin treatment in hypertensive cerebral hemorrhage after minimally invasive scavenging surgery

Objective To evaluate the effect of aescine sodium combined with albumin in the treatment of hypertensive intracerebral hemorrhage after intracranial hematoma minimally invasive removal surgery. Methods 50 patients with hypertensive intracerebral hemorrhage after intracranial hematoma minimally invasive removal surgery were randomly divided into the two groups: the treatment group was treated with aescine sodium and albumin, the control group was treated with the conventional medical drugs; The neural function defect scale, brain edema area of postoperative patients after 1d and 15d, clinical effects after 15d were observed. Results 15d after operation,in the treatment group,the brain edema area was(2.40±0.32)cm2, neural function defect scale was(9.44±2.25)points, which were better than(3.40±0.85)cm2(t= 4.721,P< 0.01)and(15.65 ±3.04)points(t= 3.625,P< 0.01). The total effective rate of the treatment group was 88.9%,which was better than 69.6% of the control group(χ2= 13.58,P< 0.01). Conclusion Aescine sodium combined with albumin can effectively reduce perihematomal brain edema area, improve nerve function defect and clinical effect in the patients with hypertensive cerebral hemorrhage after minimally invasive scavenging surgery. Key words: Cerebral Hemorrhage; Hematoma; Aescine sodium; Albumins