Early recovery and better evacuation rate in neuroendoscopic surgery for spontaneous intracerebral hemorrhage using a multifunctional cannula: preliminary study in comparison with craniotomy.
Neuroendoscopy is a promising therapeutic option for spontaneous intracerebral hemorrhage (ICH). We sought to compare the clinical outcomes between neuroendoscopic surgery and craniotomy for spontaneous ICH. We retrospectively analyzed the clinical and radiographic data of 43 patients treated with 23 neuroendoscopic procedures (endoscopy group) and 20 microsurgical procedures (craniotomy group). Rebleeding rate, surgical complications, and/or death were identified as primary clinical endpoints during the 2-month postoperative follow-up period. Evacuation rate, Glasgow Coma Scale (GCS) score at day 7, and Glasgow Outcome Scale (GOS) score were compared as well. A composite primary endpoint was observed in 5 cases (11.6%), including 1 postoperative death in the endoscopy group (4.3%) and 4 postoperative deaths in the craniotomy group (20.0%). No rebleeding was observed in the endoscopy group. The evacuation rate was significantly higher in the endoscopy group compared with the craniotomy group (99.0% vs 95.9%; P < .01). Mean GCS score at day 7 was 12 for the endoscopy group and 9.1 for the craniotomy group (P < .05). The mean change in GCS score was +4.8 for the endoscopy group and -0.1 for the craniotomy group (P < .001). Our data indicate that in patients with ICH, endoscopic surgery is safe and feasible, and may promote earlier recovery. Our results warrant a future prospective, randomized, controlled efficacy trial.
Nagasaka
Toru
T
Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65Tsurumai-Cho, Nagoya, Aichi, Japan. toru-ngy@umin.ac.jp
Tsugeno
Masanori
M
Ikeda
Hiroshi
H
Okamoto
Takeshi
T
Inao
Suguru
S
Wakabayashi
Toshihiko
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057785:Catheters; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D003399:Craniotomy / Q000009:adverse effects / Q000401:mortality; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D010865:Pilot Projects; D020127:Recovery of Function; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome