Lobo Kaike, Santos Cláudia, Campos Pedro, Oliveira Larah, da Silva Vithor Ely Bortolin
Department of Neurosurgery, State University of Pará, Belém, Brazil.
Department of Neurosurgery, UniFG Centro Universitário, Guanambi, Brazil.
Neurosurg Rev. 2025 Jan 15;48(1):50. doi: 10.1007/s10143-025-03213-w.
Basal ganglia hemorrhage (BGH) is a prevalent site for intracerebral hemorrhage. Although neuroendoscopy (NE) surgery has emerged as a less invasive alternative to craniotomy (CT), the optimal surgical method remains debatable. This systematic review and meta-analysis aimed to compare the efficacy and safety of NE versus CT in the management of BGH. A systematic search of PubMed, Embase, Cochrane Library, and Web of Science databases was conducted to identify eligible randomized controlled trials (RCTs) comparing NE surgery with CT in BGH patients. Outcomes included mortality, hematoma evacuation rate, good functional outcome (GFO), operative time, infection, pulmonary infection, and postoperative complication. Risk of bias was assessed with Cochrane's ROB-2 tool. Four RCTs were included, comprising 423 patients. NE surgery showed no significant benefit in mortality (p = 0.12) and GFO (p = 0.18). However, NE was associated with a higher hematoma evacuation rate (p = 0.007), shorter operative time (p < 0.00001), and lower rates of infection (p < 0.0001), pulmonary infection (p < 0.0001), and postoperative complications (p < 0.00001). Future research should be designed to assess whether hematoma evacuation using either technique improves outcomes in comparison to optimal medical management in this population.
基底节区出血（BGH）是脑出血的常见部位。尽管神经内镜（NE）手术已成为一种比开颅手术（CT）侵入性更小的替代方法，但最佳手术方式仍存在争议。本系统评价和荟萃分析旨在比较NE与CT在BGH治疗中的疗效和安全性。对PubMed、Embase、Cochrane图书馆和Web of Science数据库进行系统检索，以确定比较BGH患者NE手术与CT的合格随机对照试验（RCT）。结局指标包括死亡率、血肿清除率、良好功能结局（GFO）、手术时间、感染、肺部感染和术后并发症。采用Cochrane的ROB-2工具评估偏倚风险。纳入了4项RCT，共423例患者。NE手术在死亡率（p = 0.12）和GFO（p = 0.18）方面未显示出显著益处。然而，NE与更高的血肿清除率（p = 0.007）、更短的手术时间（p < 0.00001）以及更低的感染率（p < 0.0001）、肺部感染率（p < 0.0001）和术后并发症发生率（p < 0.00001）相关。未来的研究应设计评估与该人群的最佳药物治疗相比，使用这两种技术进行血肿清除是否能改善结局。
