Department of Neurosurgery, Federal University of Ceará, Av. Cmte. Maurocélio Rocha Pontes, 100 - Jocely Dantas de Andrade Torres, Sobral - CE, Sobral, 62042-250, Brazil.
School of Medicine, Federal University of Ceará, Sobral, Brazil.
Neurosurg Rev. 2024 Jun 4;47(1):255. doi: 10.1007/s10143-024-02492-z.
Neuroendoscopy (NE) surgery emerged as a promising technique for the treatment of spontaneous intracerebral hemorrhage (ICH). A previous meta-analysis of randomized controlled trials (RCTs) analyzed the efficacy and safety of NE compared to craniotomy, but NE did not present a significant improvement in functional outcomes. However, a new study provided an opportunity to update the current knowledge. We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials for RCTs reporting NE evacuation of spontaneous supratentorial ICH compared to craniotomy. The efficacy outcomes of interest were favorable functional outcome, functional disability, hematoma evacuation rate, and residual hematoma volume. The safety outcomes of interest were rebleeding, infection, and mortality. Seven RCTs were included containing 879 patients. The NE approach presented a significantly higher rate of favorable functional outcome compared with craniotomy (RR: 1.42; 95% CI 1.17, 1.73; p < 0.001). The evacuation rate was higher in patients who underwent the NE approach (MD: -8.36; 95% CI -12.66, -4.07; p < 0.001). NE did not show a benefit in improving the mortality rate (RR: 0.81, 95% CI 0.54, 1.22; p = 0.32). NE was associated with more favorable functional outcomes and lower rates of functional disabilities compared to craniotomy. Also, NE was superior regarding evacuation rate, while presenting a reduction in residual hematoma volume. NE might be associated with lower infection rates. Mortality was not improved by NE surgery. Larger, higher-quality randomized studies are needed to adequately evaluate the efficacy and safety of NE compared to craniotomy.
神经内镜（NE）手术作为一种治疗自发性脑出血（ICH）的有前途的技术出现了。先前对随机对照试验（RCT）的荟萃分析分析了与开颅术相比 NE 的疗效和安全性，但 NE 并未在功能结局方面表现出显著改善。然而，一项新的研究提供了更新当前知识的机会。我们在 PubMed、Embase 和 Cochrane 对照试验中心注册库中搜索了报告与开颅术相比使用 NE 清除自发性幕上 ICH 的 RCT。感兴趣的疗效结局是良好的功能结局、功能障碍、血肿清除率和残余血肿体积。感兴趣的安全性结局是再出血、感染和死亡率。纳入了 7 项 RCT，共包含 879 名患者。与开颅术相比，NE 方法呈现出更高的良好功能结局率（RR：1.42；95%CI 1.17，1.73；p<0.001）。接受 NE 方法的患者的清除率更高（MD：-8.36；95%CI -12.66，-4.07；p<0.001）。NE 并没有显示出改善死亡率的益处（RR：0.81，95%CI 0.54，1.22；p=0.32）。与开颅术相比，NE 与更好的功能结局和更低的功能障碍发生率相关。此外，NE 在清除率方面表现出色，同时降低了残余血肿体积。NE 可能与较低的感染率相关。NE 手术并未改善死亡率。需要更大、更高质量的随机研究来充分评估与开颅术相比 NE 的疗效和安全性。
