Custodio John Emmanuel Y, Navarro Joseph Erroll V, Malilay Oliver Ryan M
Section of Neurosurgery, Department of Surgery, Jose R. Reyes Memorial Medical Center, Santa Cruz, Manila, Philippines.
Asian J Neurosurg. 2025 May 20;20(3):478-484. doi: 10.1055/s-0045-1809166. eCollection 2025 Sep.
Primary spontaneous Intracerebral Hemorrhage (PSICH) is a devastating disease occurring in 24.6 cases per 100,000 people per year, more common with chronic arterial hypertension. Emergent hematoma evacuation remains a lifesaving intervention especially in younger patients with large hematoma volume and are clinically deteriorating. Timely and appropriate management is key to improving outcomes. In this study, we compared whether conventional craniotomy or neuroendoscopic surgery would lead to improved mortality and better functional outcomes in patients with PSICH. Specifically, we wanted to determine the extent of hematoma clearance, intraoperative blood loss, intraoperative time, degree of rebleeding, total complications, and length of hospital stay among the surgical approaches utilized. We searched from the Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE/PubMed, the U.S. National Institutes of Health Ongoing Trials Register, Embase database, Health Research and Development Information Network (HERDIN), and the World Health Organization International Clinical Trials Registry Platform for studies to be included. Patients with deep hypertensive intracerebral hemorrhage of either sex, aged 18 to 60 years, with a Glasgow Coma Score of 6 to 12, with hematoma volume of 30 to 80 mL, and received treatment within 24 hours with either conventional craniotomy or neuroendoscopic surgery were allowed. Outcomes evaluated were mortality and functional outcome. The risk of bias was assessed using the ROBINS-I tool for nonrandomized studies. The final search yielded four eligible studies. Both conventional craniotomy and neuroendoscopic surgery did not show any statistically significant difference in postoperative mortality (risk ratio [RR]: 1.32, 95% confidence interval [CI]: 0.48-3.62, = 0.59, I : 42%) and postoperative functional outcome (RR: 3.17, 95% CI: 0.76-13.3, = 0.11, I : 83%). Neuroendoscopic surgery showed statistically significant shorter operative time. Both interventions yielded similar results in amount of volume evacuated, intraoperative blood loss, length of hospital stay, number of rebleeding, and total complications. This meta-analysis and review shows that conventional craniotomy and neuroendoscopic surgery both lead to good postoperative functional outcomes with similar death rates. Neuroendoscopic surgery showed statistically significant shorter operative time. Both interventions result in high volume of hematoma evacuated, low number of rebleeding, and total complications, as well as similar amount of intraoperative blood loss and length of hospital stay.
原发性自发性脑出血（PSICH）是一种具有破坏性的疾病，每年每10万人中有24.6例发病，在慢性动脉高血压患者中更为常见。紧急血肿清除术仍然是一种挽救生命的干预措施，特别是对于血肿量大且临床状况恶化的年轻患者。及时且恰当的管理是改善预后的关键。在本研究中，我们比较了传统开颅手术和神经内镜手术在PSICH患者中是否能降低死亡率并带来更好的功能预后。具体而言，我们想确定在所采用的手术方法中，血肿清除程度、术中失血量、手术时间、再出血程度、总并发症以及住院时间的情况。我们在Cochrane图书馆的Cochrane对照试验中央登记库、MEDLINE/PubMed、美国国立卫生研究院正在进行的试验登记库、Embase数据库、健康研究与发展信息网络（HERDIN）以及世界卫生组织国际临床试验注册平台中检索纳入研究。纳入年龄在18至60岁、格拉斯哥昏迷评分在6至12分、血肿量为30至80 mL、在24小时内接受传统开颅手术或神经内镜手术治疗的男女深部高血压性脑出血患者。评估的结局为死亡率和功能预后。使用ROBINS - I工具对非随机研究进行偏倚风险评估。最终检索得到四项符合条件的研究。传统开颅手术和神经内镜手术在术后死亡率（风险比[RR]：1.32，95%置信区间[CI]：0.48 - 3.62，P = 0.59，I²：42%）和术后功能预后（RR：3.17，95% CI：0.76 - 13.3，P = 0.11，I²：83%）方面均未显示出任何统计学上的显著差异。神经内镜手术的手术时间在统计学上显著更短。两种干预措施在血肿清除量、术中失血量、住院时间、再出血次数和总并发症方面产生的结果相似。这项荟萃分析和综述表明，传统开颅手术和神经内镜手术均能带来良好的术后功能预后，死亡率相似。神经内镜手术的手术时间在统计学上显著更短。两种干预措施均能实现大量血肿清除、低再出血次数和总并发症，以及相似的术中失血量和住院时间。
