Comparison of clinical efficacy of neuroendoscopy and microscopic surgery on early hypertensive intracerebral hemorrhage in basal ganglia

doi:10.3877/cma.j.issn.2095-123X.2022.02.002

Abstract

Abstract:

Objective

To analyze and compare the efficacy of neuroendoscopic surgery and microscopic craniotomy in the treatment of early basal ganglia hypertensive intracerebral hemorrhage (HICH).

Methods

The clinical data of 188 patients with early basal ganglia HICH treated in Neurosurgery Department of Zhangjiakou First Hospital from March 2016 to March 2021 were analyzed retrospectively. According to surgical methods, 95 cases were enrolled into neuroendoscopic group and 93 cases were in microscopic group. The intraoperative blood loss, operation duration, the hematoma clearance rate, the incidence of complications (intracranial infection) and the score of modified Rankin scale (mRs) at 6 months after operation were compared and analyzed between the two groups.

Results

The neuroendoscopy group was compared with the microscope group, the operation duration was significantly shortened [(96.6±10.7) min vs (171.3±26.4) min], the amount of intraoperative bleeding was significantly reduced [(32.8±6.2) mL vs (112.8.0±17.0) mL], and the hematoma clearance rate was increased (95.9%±4.2% vs 87.4%±6.5%), the differences were statistically significant (all P<0.05). There was no significant difference in complications between two groups (P>0.05). According to the mRs score at 6 months after operation, the good prognosis rate of neuroendoscopy group (26.3%, 25/95) was higher than that of microscope group (15.1%, 14/93) (P<0.05).

Conclusion

For the patients with early basal ganglia HICH, less time was needed in neuroendoscopic surgery than that in microscopic surgery. Additionally, there was more clear visual field and better prognosis under neuroendoscopic surgery, indicating that neuroendoscopic surgery is a safer surgery method.

Key words: Hypertensive intracerebral hemorrhage, Basal ganglia, Neuroendoscopic surgery, Microscopic surgery, Early

Lizhong Wang, Junsheng Chu, Lihui Zhao, Huiyuan Sun, Qing Hou, Qi Ding, Junfei Yan, Yuan Hou, Wu Yuan, Wei Wang. Comparison of clinical efficacy of neuroendoscopy and microscopic surgery on early hypertensive intracerebral hemorrhage in basal ganglia[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2022, 12(02): 69-73.

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References 22

[1]	张长福,谭占国,袁波,等.基底节区高血压性脑出血的临床治疗经验[J].中华神经外科杂志, 2017, 33(12): 1266-1267.
[2]	王晓毅,黄海林,成刚.内镜下颅内血肿清除术与开颅血肿清除术在高血压脑出血中治疗的比较[J].中华神经创伤外科电子杂志, 2020, 6(5): 283-286.
[3]	李少泉,彭文龙,张维,等.微创颅内血肿清除术联合术后尿激酶溶解治疗基底核区高血压脑出血的效果及对神经功能、预后的影响研究[J].解放军医药杂志, 2020, 32(11): 89-93.
[4]	中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国脑出血诊治指南(2019)[J].中华神经科杂志, 2019, 52(12): 994-1005.
[5]	唐华民,周建国,张剑锋,等.两种手术方式治疗高血压脑出血的对比研究[J].中华急诊医学杂志, 2018, 27(4): 425-429.
[6]	Hemphill JC 3rd, Greenberg SM, Anderson CS, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2015, 46(7): 2032-2060.
[7]	Bernardo F, Rebordão L, Machado S, et al. In-hospital and long-term prognosis after spontaneous intracerebral hemorrhage among young adults aged 18-65 years[J]. J Stroke Cerebrovasc Dis, 2019, 28(11): 104350.
[8]	韩鹏,李旭琴,于天元,等.应用神经导航结合神经内镜治疗高血压脑出血的疗效分析[J].中华神经外科杂志, 2018, 34(6): 572-575.
[9]	Kellner CP, Chartrain AG, Nistal DA, et al. The stereotactic intracerebral hemorrhage underwater blood aspiration (SCUBA) technique for minimally invasive endoscopic intracerebral hemorrhage evacuation[J]. J Neurointerv Surg, 2018, 10(8): 771-776.
[10]	杨彦龙,常涛,郭少春,等.神经内镜下治疗幕上高血压脑出血[J].中华神经外科杂志, 2017, 33(7): 733-736.
[11]	Zhao XH, Zhang SZ, Feng J, et al. Efficacy of neuroendoscopic surgery versus craniotomy for supratentorial hypertensive intracerebral hemorrhage: a meta-analysis of randomized controlled trials[J]. Brain Behav, 2019, 9(12): e01471.
[12]	赵伟,袁建伟,宋腾,等.经额中回内镜辅助与常规开颅清除基底节区血肿的对比研究[J].中国实用神经疾病杂志, 2020, 23(17): 1534-1538.
[13]	Xu X, Chen X, Li F, et al. Effectiveness of endoscopic surgery for supratentorial hypertensive intracerebral hemorrhage: a comparison with craniotomy[J]. J Neurosurg, 2018, 128(2): 553-559.
[14]	周贤文,张志远,周世聪,等.神经内镜微创与开颅血肿清除术治疗高血压脑出血的效果比较[J].中国实用医刊, 2020, 47(13): 53-56.
[15]	Eroglu U, Kahilogullari G, Dogan I, et al. Surgical management of supratentorial intracerebral hemorrhages: endoscopic versus open surgery[J]. World Neurosurg, 2018, 114: e60-e65.
[16]	刘俊.内镜下颅内血肿清除术与开颅血肿清除术治疗高血压脑出血的效果比较[J].中国当代医药, 2021, 28(31): 78-81.
[17]	Pasi M, Sugita L, Xiong L, et al. Association of cerebral small vessel disease and cognitive decline after intracerebral hemorrhage[J]. Neurology, 2021, 96(2): e182-e192.
[18]	石立科,向定朝,何建青,等.老年基底核区脑出血患者微创治疗策略选择对不同时期神经功能与预后影响[J].中华老年心脑血管病杂志, 2022, 24(2): 167-170.
[19]	Huang CJ, Liu X, Zhou XT, et al. Neuroendoscopy-assisted evacuation of chronic subdural hematoma with mixed CT density through a novel small bone flap[J]. J Neurol Surg A Cent Eur Neurosurg, 2020, 81(6): 549-554.
[20]	Katsuki M, Kakizawa Y, Nishikawa A, et al. Endoscopic hematoma removal of supratentorial intracerebral hemorrhage under local anesthesia reduces operative time compared to craniotomy[J]. Sci Rep, 2020, 10(1): 10389.
[21]	Kellner CP, Song R, Pan J, et al. Long-term functional outcome following minimally invasive endoscopic intracerebral hemorrhage evacuation[J]. J Neurointerv Surg, 2020, 12(5): 489-494.
[22]	王立忠,初君盛,赵立辉,等.神经内镜手术治疗早期高血压性基底核区出血的临床疗效分析[J].中华神经外科杂志, 2020, 36(12): 1252-1255.

项目	神经内镜组（n=95）	显微镜组（n=93）	χ²/t值	P值
性别（男/女）	45/50	48/45	0.190	0.663
年龄（岁，Mean±SD）	58.4±6.4	59.3±6.6	1.004	0.317
术前GCS评分（分，Mean±SD）	9.7±2.0	9.4±2.2	1.035	0.302
术前血肿量（mL，Mean±SD）	46.1±7.9	46.8±7.9	0.621	0.535
发病至手术时间（min，Mean±SD）	3.1±0.7	3.0±0.7	0.225	0.822

项目	神经内镜组（n=95）	显微镜组（n=93）	χ²/t值	P值
性别（男/女）	45/50	48/45	0.190	0.663
年龄（岁，Mean±SD）	58.4±6.4	59.3±6.6	1.004	0.317
术前GCS评分（分，Mean±SD）	9.7±2.0	9.4±2.2	1.035	0.302
术前血肿量（mL，Mean±SD）	46.1±7.9	46.8±7.9	0.621	0.535
发病至手术时间（min，Mean±SD）	3.1±0.7	3.0±0.7	0.225	0.822

项目	神经内镜组（n=95）	显微镜组（n=93）	t/χ²值	P值
手术时间（min，Mean±SD）	96.64±10.74	171.28±26.36	25.520	<0.001
术中出血量（mL，Mean±SD）	32.76±6.22	112.85±16.98	43.120	<0.001
血肿清除率（%，Mean±SD）	95.91±4.19	87.43±6.46	10.700	<0.001
颅内感染[例（%）]	3（3.16）	5（5.38）	0.154	0.695

项目	神经内镜组（n=95）	显微镜组（n=93）	t/χ²值	P值
手术时间（min，Mean±SD）	96.64±10.74	171.28±26.36	25.520	<0.001
术中出血量（mL，Mean±SD）	32.76±6.22	112.85±16.98	43.120	<0.001
血肿清除率（%，Mean±SD）	95.91±4.19	87.43±6.46	10.700	<0.001
颅内感染[例（%）]	3（3.16）	5（5.38）	0.154	0.695

组别	例数	预后良好	中度残疾	重度残疾	植物生存	死亡
神经内镜组	95	25（26.3）	44（46.3）	20（21.0）	5（5.3）	1（1.1）
显微镜组	93	14（15.1）	40（43.0）	25（26.9）	12（12.9）	2（2.1）
U值		4.281
P值		0.010

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