Endoscopic Surgery Without Decompressive Craniectomy in Large Putaminal Intracerebral Hemorrhage: Assessment of Efficacy and Safety

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Abstract

Background

Decompressive craniectomy (DC) is performed conventionally for large putaminal intracerebral hemorrhage (ICH). However, DC causes local skull defect and leads to post-surgical cranioplasty. The aim of this study is to investigate the effectiveness and safety of an endoscopic procedure to treat large putaminal ICH without DC.

Methods

This retrospective study included 112 large putaminal ICH patients who underwent hematoma evacuations with either an endoscopic procedure (group A) or with DC (group B) between January 2009 and June 2017. The efficacy was evaluated by mean modified Rankin Scale (mRS) three months after surgery. Safety was evaluated by mortality rate and postoperative complications. Univariate and multivariate logistic regression analyses were performed to determine the risk factors for clinical outcomes.

Results

The study included 49 patients in group A and 63 in group B. The mRS scores in both groups were similar after 3 months’ follow-up ( p = 0.709). There was no difference in the mortality rate between the two groups ( p = 0.538). The rate of complications was lower in group A than that in group B ( p = 0.024). Smaller preoperative midline shift ( p = 0.008) and absent intraventricular extension ( p = 0.044) have contributed significantly to better outcomes.

Conclusion

Endoscopic hematoma evacuation without DC is safe and effective for patients with large putaminal ICH and deserves further investigation, preferably in a randomized controlled setting.

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Most cited references 29

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Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

J Claude Hemphill, Steven Greenberg, Craig Anderson … (2015)

The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of spontaneous intracerebral hemorrhage.

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Surgical complications secondary to decompressive craniectomy in patients with a head injury: a series of 108 consecutive cases.

R Lou, F. Shen, Guangxi Li … (2008)

Decompressive craniectomy is an important method for managing refractory intracranial hypertension in patients with head injury. We reviewed a large series of patients who underwent this surgical procedure to establish the incidence and type of postoperative complications. From 1998 to 2005, decompressive craniectomy was performed in 108 patients who suffered from a closed head injury. The incidence rates of complications secondary to decompressive craniectomy and risk factors for developing these complications were analysed. In addition, the relationship between outcome and clinical factors was analysed. Twenty-five of the 108 patients died within the first month after surgical decompression. A lower GCS at admission seemed to be associated with a poorer outcome. Complications related to surgical decompression occurred in 54 of the 108 (50%) patients; of these, 28 (25.9%) patients developed more than one type of complication. Herniation through the cranial defect was the most frequent complication within 1 week and 1 month, and subdural effusion was another frequent complication during this period. After 1 month, the "syndrome of the trephined" and hydrocephalus were the most frequent complications. Older patients and/or those with more severe head trauma had a higher occurrence rate of complications. The potential benefits of decompressive craniectomy can be adversely affected by the occurrence of complications. Each complication secondary to surgical decompression had its own typical time window for occurrence. In addition, the severity of head injury was related to the development of a complication.

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Natural history of perihematomal edema in patients with hyperacute spontaneous intracerebral hemorrhage.

John Duldner, Jane Khoury, T Brott … (2002)

The natural history of perihematomal edema in human hyperacute spontaneous intracerebral hemorrhage (ICH) has not been well described. This study was a secondary analysis of a previously reported prospective, population-based study of hematoma growth in 142 patients with spontaneous ICH. Patients were first imaged within 3 hours of onset, then 1 and 20 hours later. We excluded patients with anticoagulant use (n=7), underlying aneurysm/vascular malformation (n=9), trauma (n=1), incomplete data (n=20), infratentorial ICH (n=17), and no consent (n=2), leaving an overall study population of 86 patients. From this overall group we further excluded patients with intraventricular extension (n=38), subsequent surgery (n=5), or death (n=2) before 20-hour postbaseline CT. This second, "restricted" analysis group of 41 patients was relatively devoid of clinical or radiological variables likely to confound edema measurement. Absolute and relative edema volumes (edema volume divided by hematoma volume) were descriptively summarized. Correlations between baseline edema volumes and relevant clinical and radiological variables were then performed. Overall, median absolute edema volume increased from 6.93 to 14.4 cm(3) during the first 24 hours after ICH, and median relative edema volume increased from 0.47 to 0.81. In the restricted group, median absolute edema volume was 7.4 cm(3) at baseline and 11.0 cm(3) at 24 hours after ICH, and median relative edema volume increased from 0.55 to 0.81. Baseline relative edema volume was significantly negatively correlated with subsequent change in relative edema volume from baseline to 20-hour CT (r=0.57, P=0.0002) but was not significantly correlated with other clinical and radiological variables, including hematoma volume or change in hematoma volume. Perihematomal edema volume increases by approximately 75% during the first 24 hours after hyperacute spontaneous ICH. Patients with the least amounts of baseline relative edema volume were most likely to develop significant additional amounts of edema during the first 24 hours after spontaneous ICH.

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Author and article information

Contributors

Qiujing Wang: qiujingwang1@126.com

Journal

Journal ID (nlm-ta): Neurocrit Care

Journal ID (iso-abbrev): Neurocrit Care

Title: Neurocritical Care

Publisher: Springer US (New York )

ISSN (Print): 1541-6933

ISSN (Electronic): 1556-0961

Publication date (Electronic): 16 December 2019

Publication date PMC-release: 16 December 2019

Publication date (Print): 2020

Volume: 32

Issue: 2

Pages: 392-399

Affiliations

[1 ]GRID grid.284723.8, ISNI 0000 0000 8877 7471, The National Key Clinical Specialty, The Engineering Technology Research Center of Ministry of Education of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, , Southern Medical University, ; Guangzhou, 510282 Guangdong Province China

[2 ]GRID grid.477425.7, Department of Neurosurgery, , Liuzhou General Hospital, ; Liuzhou, 545001 Guangxi Autonomous Region China

Article

Publisher ID: 880

DOI: 10.1007/s12028-019-00880-8

PMC ID: 7082409

PubMed ID: 31845172

SO-VID: 99eaca69-4a4d-4b8a-948c-01a5f23f0638

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Funding

Funded by: Water Resources Department of Guangdong Province (CN)

Award ID: 2015A030313259

Award Recipient : Qiujing Wang

Funded by: Key Project of Clinical Research of Southern Medical University

Award ID: LC2016PY59

Award Recipient : Qiujing Wang

Custom metadata

issue-copyright-statement © Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2020

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: endoscopic surgery,intracerebral hemorrhage,outcome,cerebrospinal fluid drainage

Data availability:

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: endoscopic surgery, intracerebral hemorrhage, outcome, cerebrospinal fluid drainage

Endoscopic Surgery Without Decompressive Craniectomy in Large Putaminal Intracerebral Hemorrhage: Assessment of Efficacy and Safety

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Abstract

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Methods

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Irish Journal of Paramedicine

Most cited references 29

Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

Surgical complications secondary to decompressive craniectomy in patients with a head injury: a series of 108 consecutive cases.

Natural history of perihematomal edema in patients with hyperacute spontaneous intracerebral hemorrhage.

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