title: Endoscope-Assisted Keyhole Technique for Hypertensive Cerebral Hemorrhage in Elderly Patients: A Randomized Controlled Study in 184 Patients.
abstract: OBJECTIVE
  Hypertensive cerebral hemorrhage (HCH) is a potentially life-threatening cerebrovascular disease with high mortality. In case of a massive hematoma, surgical drainage is a crucial treatment. The aim of the present study was to assess the efficacy of the endoscope-assisted keyhole technique in elderly patients with intracerebral hematoma who needed a flap craniotomy as traditional treatment.
  
  
  METHODS
  One hundred-eighty-four elderly patients with HCH, who had craniotomy indications after conservative treatment for 6-24 hours after onset, were randomly divided into two groups. In the craniotomy group, traditional hematoma drainage was performed. In the keyhole group, an endoscope-assisted keyhole technique was used. Anesthesia time, blood loss, hematoma drainage rate, and complications were compared. The clinical primary outcome was the six-month efficacy rate (defined by the activities of daily living (ADL) score).
  
  
  RESULTS
  Anesthesia time was longer in the craniotomy group (3.43 ± 0.65 vs. 1.53 ± 0.52 h, P < 0.01), and blood losses were more important (256 ± 129 vs. 96 ± 39 ml P < 0.01). There was no difference in hematoma drainage rate between the two groups (77.25 ± 13.44 vs. 83.52 ± 27.51% P > 0.05). Complications, including tracheotomy (P < 0.01), pulmonary infection (P < 0.01) and hypoproteinemia (P < 0.05) were more frequent in the craniotomy group. There was no difference in the occurrence of other complications, including revision surgery digestive tract ulcer and epilepsy. Proportion of patients with good prognosis (ADL I-III) was larger in the keyhole group (P < 0.05).
  
  
  CONCLUSIONS
  In elderly HCH patients with an indication for hematoma drainage, better outcomes were achieved using an endoscope-assisted keyhole technique.
authors.affiliation: Anhui Medical University, School of Clinical Medicine (101-Hospital), Wuxi, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Feng
authors.forename: Jianqing
authors.initials: J
authors.lastname: He
authors.forename: Bin
authors.initials: B
authors.lastname: Liu
authors.forename: Likun
authors.initials: L
authors.lastname: Yang
authors.forename: Yuhai
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003399:Craniotomy; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D020299:Intracranial Hemorrhage, Hypertensive / Q000601:surgery*; D008297:Male; D044583:Neuroendoscopy / Q000379:methods*; D016896:Treatment Outcome