Surgical management for large hypertensive basal ganglionic hemorrhage: single center experience

Short-term outcomes of endoscopic evacuation of supratentorial spontaneous intracerebral hematoma: Early experience from developing country

Background:

Minimally invasive endoscopic hematoma evacuation is a promising treatment option for intracerebral hemorrhage (ICH). However, the technique still needs improvement.

Methods:

We report our early clinical experience of using this technique to evacuate supratentorial spontaneous intracerebral hematomas and evaluate its short-term outcomes.

Results:

The study included 15 patients, basal ganglia hematoma was the most common location 62.5%, mean preoperative hematoma volume was 61.07 cc, mean ICH score was 3, and mean rate of hematoma evacuation was 89.27%. Factors that could be related to mortality were Glasgow Coma Score (GCS) on admission (P = 0.001), ICH score (P = 0.004); postoperative GCS (P < 0.001), postoperative hematoma volume (P = 0.006); intraventricular extension (P = 0.001), and rate of evacuation (P = 0.001).

Conclusion:

Endoscopic technique is a safe surgical option for evacuation of spontaneous supratentorial ICH. This minimally invasive technique could be helpful to provide better short-term outcomes for selected patients. However, in our experience, this minimally invasive technique did not change the outcome for cases presented with poor GCS on admission 4/15. Our results warrant a future prospective, randomized, controlled efficacy trial.

Mini Craniotomy in the Management of Supratentorial Spontaneous Intracranial Hemorrhage: A Single-Center Outcome of the Minimally Invasive Treatment

Hemorrhagic stroke accounts for a significant proportion of mortality and confers a poor quality of life with high dependency among survivors. Surgical evacuation of hematoma has the advantage of rapidly controlling the increased intracranial pressure, halting the ongoing herniation syndrome, and mitigating the secondary cascades of events mediated by the inflammatory and blood degradation products. The advantage is hindered by the concurrent insult to the healthy brain tissue while passing through the normal brain tissue. Therefore, minimally invasive approaches to evacuate the hematoma are employed, but the need for an expensive surgical armamentarium and the expert multidisciplinary team is the bottleneck for their application, particularly in low-income nations. We herein performed a study upon the role of mini craniotomy open surgical method of evacuating hematoma in selected patients with supratentorial intracerebral hemorrhage. We found a significant reduction in the surgery length, minimized risk of post-surgery complications, shortened intensive care unit stay, and reduced mortality compared to the full-fledged craniotomy and endoscopy-guided surgery. There is a need for a large-scale randomized multicenter prospective study to verify the advantages of minimally invasive approaches in the management of symptomatic supratentorial intracerebral hemorrhages.