Kondabathini Rajeshwari, Venishetty Nagaraju, Madineni Komal Usha
Department of Neurological Surgery, Krishna Institute of Medical Sciences, Hyderabad, IND.
Department of Neurological Surgery, St. John's Medical College, Bengaluru, IND.
Cureus. 2024 Jun 12;16(6):e62233. doi: 10.7759/cureus.62233. eCollection 2024 Jun.
Objective In patients with intracerebral hemorrhage (ICH), the usage of microsurgical instrumentation and techniques can reduce traction-related injuries and enhance postoperative outcomes compared with traditional hematoma evacuation. The purpose of this study was to compare the results of endoscopic evacuation of spontaneous non-traumatic ICH with conventional open craniotomies and evacuations of ICH in terms of safety, feasibility, and neurological outcomes. Methods This was a prospective study that included 21 patients with spontaneous intracerebral hematomas managed by surgical evacuation endoscopically and another 24 patients with spontaneous supratentorial ICH who underwent hematoma evacuation by open craniotomy. Primary outcomes included operation duration, operative blood loss, hematoma evacuation rate, re-bleeding rate, and postoperative Glasgow Coma Scale (GCS) score. Results The median operation durations were 110 (90-200) and 230 (120-460) minutes in the endoscopic and open procedure groups, respectively (p = 0.00001). The median operative blood loss was 160 (80-300) and 530 (100-2000) mL in the endoscopic and open procedure groups, respectively (p < 0.00001). The median hematoma removal rates were 90% (60%-99%) and 85% (60%-100%) in the endoscopic and open procedure groups, respectively (p = 0.0348). Re-bleeding rates were higher in the endoscopic group (p = 0.46). Postoperative Glasgow Outcome Scale scores at two-month and six-month intervals were similar between the groups (p = 0.87). Conclusion Endoscopic hematoma evacuation for spontaneous supratentorial hemorrhage is becoming a standard surgical procedure, and promising clinical results can be expected. In addition, an endoscope can enhance time efficiency, hematoma evacuation rates, and reduce bleeding. Although endoscopic surgeries have higher re-bleeding rates, the difference is not significant when compared to open craniotomies with similar postoperative GCS scores. It is therefore important to be familiar with the endoscope and its associated equipment in order to achieve better results and reduce complications.
目的 在脑出血（ICH）患者中，与传统血肿清除术相比，显微手术器械和技术的使用可减少与牵引相关的损伤并改善术后结果。本研究的目的是比较内镜下清除自发性非创伤性ICH与传统开颅手术及ICH清除术在安全性、可行性和神经学结果方面的差异。方法 这是一项前瞻性研究，纳入了21例通过内镜手术清除自发性脑内血肿的患者以及另外24例接受开颅血肿清除术的自发性幕上ICH患者。主要结局包括手术时间、术中失血量、血肿清除率、再出血率和术后格拉斯哥昏迷量表（GCS）评分。结果 内镜手术组和开颅手术组的中位手术时间分别为110（90 - 200）分钟和230（120 - 460）分钟（p = 0.00001）。内镜手术组和开颅手术组的中位术中失血量分别为160（80 - 300）毫升和530（100 - 2000）毫升（p < 0.00001）。内镜手术组和开颅手术组的中位血肿清除率分别为90%（60% - 99%）和85%（60% - 100%）（p = 0.0348）。内镜组的再出血率更高（p = 0.46）。两组在术后2个月和6个月时的格拉斯哥预后量表评分相似（p = 0.87）。结论 内镜下清除自发性幕上出血正成为一种标准的手术方法，并有望取得良好的临床效果。此外，内镜可提高时间效率、血肿清除率并减少出血。虽然内镜手术的再出血率较高，但与术后GCS评分相似的开颅手术相比，差异并不显著。因此，熟悉内镜及其相关设备对于取得更好的效果和减少并发症很重要。
