Clinical Sdudy Between Neuroendoscopic Surgery And Small Bone Window Hematoma Evacuation In Hypertensive Cerebral Hemorrhage In Basal Ganglia

Background: Hypertensive basal ganglia intracerebral hemorrhage is a disease with high morbidity, high mortality and high morbidity. Surgical management is an important treatment for hypertensive basal ganglia intracerebral hemorrhage. However, as many studies have shown, traditional craniotomy can not result in better outcomes compare with conservative treatment. Endoscopic surgery is a novel minimally invasive surgical technique with an undefined clinical efficacy in treating hypertensive basal ganglia intracerebral hemorrhage.Methods: Seventy-four patients with hypertensive basal ganglia intracerebral hemorrhage treated in Department of Neurosurgery, Affiliated Hospital of Yan’an University during May 2012 and May 2014 were enrolled. Twenty-four patients underwent endoscopic surgery(neuroendoscope group) and 50 patients underwent small bone window hematoma evacuation(control group) were randomly selected as control. Operative time, blood loss, evacuation rate, postoperative hospital stay, mortality, incidence of postoperative complications, postoperative 24 hours Glasgow Coma Score(GCS), postoperative 1 month and 6 months Activities of Daily Living(ADL) score were compared between two groups. Patients were subgrouped according to age, volume of hemorrhage, intraventricular hemorrhage, preoperative Modified Edinburgh Scandinavia score(MESSS) and preoperative GCS score. In each subgroup, postoperative 1 month and 6 months ADL score were compared between two surgical groups.Outcomes: There were no significant differences between two groups in gender ratio, age, systolic blood pressure, volume of hemorrhage, bleeding sites, with or without intraventricular hemorrhage, preoperative GCS score and preoperative MESSS score(p>0.05). Neuroendoscope group had a shorter operative time, less blood loss, higher evacuation rate and fewer postoperative hospital stay(p <0.05). There were no significant differences between two groups in postoperative mortality, incidence of surgery-related complications, postoperative 24 hours GCS score(p> 0.05). In subgroups, patients underwent endoscopic surgery with volume of bleeding between 30-50 ml, preoperative MESSS score 16-30 points or preoperative GCS score ≥9 points had higher postoperative 1 month and 6 months average ADL scores than control group(p <0.05).Conclusion:1.Compared with small bone window hematoma evacuation, neuroendoscopic surgery has shorter operative time, less blood loss, higher evacuation rate and fewer postoperative hospital stay in treating hypertensive basal ganglia intracerebral hemorrhage.2.There are no significant differences between neuroendoscopic surgery and small bonewindow hematoma evacuation in postoperative mortality, incidence of surgery-relatedcomplications and early treatment effect during treatment of hypertensive basal gangliaintracerebral hemorrhage.3.Neuroendoscopic surgery has a long-term treatment effect similar to small bone window hematoma evacuation in treating hypertensive basal ganglia intracerebral hemorrhage at least. For patients with volume of bleeding between 30-50 ml, preoperative MESSS score 16-30 points or preoperative GCS score ≥9 points, neuroendoscopic surgery has better long-term treatment effect than small bone window hematoma evacuation.4.Neuroendoscopic surgery is a safe and effective surgical treatment in treating hypertensive basal ganglia intracerebral hemorrhage.