Abstract
Background
Spontaneous intracerebral hemorrhage (ICH) with large hematomas is commonly treated with craniotomy combined with decompressive craniectomy, procedures that involve huge trauma and require subsequent cranioplasty. Recently, endoscopic surgery has shown significant promise in treating ICH, but its feasibility for large hematomas remains uncertain. Therefore, this study aims to compare endoscopic surgery with craniotomy and to evaluate the efficacy and safety of endoscopic surgery in treating large hematomas ICH.
Methods
A retrospective analysis was conducted on the clinical data from patients with spontaneous supratentorial ICH and hematoma volumes exceeding 50 mL who underwent either endoscopic surgery or craniotomy. Propensity score matching analysis was employed to reduce selection bias. The efficacy and safety of endoscopic surgery were evaluated by analyzing blood loss, postoperative edema, mortality rate, complications, and the Glasgow Outcome Scale (GOS) at 6-month follow-up.
Results
A total of 113 cases that met the criteria were collected, with 65 in the endoscopic surgery group and 48 in the craniotomy group. After propensity score matching, each group contained 34 cases. The mean hematoma volume was 64.84 ± 11.02 mL in the endoscopy group and 66.57 ± 12.77 mL in the craniotomy group (p = 0.554). Hematoma evacuation rates were 93.27% in the endoscopy group and 89.34% in the craniotomy group (p = 0.141). The endoscopy group exhibited lower blood loss, shorter surgical time, and reduced postoperative edema volume at 24 h compared to the craniotomy group. The rate of pulmonary infection was slightly lower in the endoscopy group compared to the craniotomy group (70.59% vs. 91.18%, p = 0.031), but there were no statistically significant differences in overall complications and mortality rate between the two groups. GOS scores were similar in both groups at the 6-month follow-up.
Conclusions
Endoscopic surgery is safe and feasible for treating spontaneous supratentorial ICH with large hematomas, demonstrating efficacy similar to that of craniotomy with decompressive craniectomy.
Key Points
- Study Design: A retrospective analysis of 113 patients with spontaneous supratentorial ICH, of whom 34 underwent endoscopic surgery and 34 craniotomy after propensity score matching.
- Hematoma Evacuation: Both groups achieved high evacuation rates, with no statistically significant difference (93.27% for endoscopy vs. 89.34% for craniotomy).
- Surgical Metrics: Endoscopic surgery resulted in significantly reduced blood loss (50 mL vs. 450 mL) and shorter operation times (140 min vs. 205 min).
- Edema and ICP: The endoscopy group exhibited significantly lower 24-hour postoperative edema (28.49 mL vs. 61.85 mL). Both groups maintained comparable intracranial pressure (ICP) levels post-surgery.
- Complication Rates: The endoscopy group experienced lower pulmonary infection rates (70.59% vs. 91.18%), though overall complication rates were similar between groups.
- Mortality and Recovery: Mortality rates and Glasgow Outcome Scale (GOS) scores at six months were comparable, with no significant differences in long-term recovery.
- Hospital Stay: Endoscopic surgery patients had shorter hospital stays (32.5 days vs. 48 days).
- Safety Profile: Endoscopic surgery demonstrated a favorable safety profile with fewer iatrogenic injuries and reduced need for postoperative cranioplasty.
- Limitations: The study is limited by its single-center retrospective design, small sample size, and reliance on surgeon expertise.
- Future Research: Larger, multicenter randomized controlled trials are needed to validate findings and expand on endoscopic surgery’s applicability in large ICH cases.
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