The Efficient And Safety Of Neuroendoscopic Surgery For Hypertensive Intracerebral Hemorrhage And Intraventricular Hemorrhage Secondary To Spontaneous Supratentorial Hemorrhage

PurposesAlthough neuroendoscopy (NE) has been applied to many cerebral diseases, the effect of NE for basal ganglia hemorrhage and intraventricular hemorrhage (IVH) secondary to spontaneous supratentorial hemorrhage remains controversial. The purpose of this study was to analyze the effect of NE approach on the management of hypertensive intracerebral hemorrhage and IVH secondary to spontaneous supratentorial hemorrhage.MethodologySection1:In this study, we analysed the clinical and radio-graphical outcomes between NE group (21cases) and traditional craniotomy group (30cases). The clinical and radio-graphical outcomes included Mortality, hematoma volume, evacuation rate, infection rates, Glasgow Coma Scale (GCS) scores, Modified Rankin Scale (mRS), and Glasgow Outcome Scale (GOS).Section2:A systematic search of electronic databases (PubMed, EMBASE, OVID, Web of Science, The Cochrane Library, CBM, VIP, CNKI, and Wan Fang database) was performed to identify related studies published from1970to2013. Randomized controlled trials (RCTs) or observational studies (OS) comparing NE with EVD alone or with IVF for the treatment of IVH were included. The quality of the included trials was assessed by Jaded scale and the Newcastle-Ottawa Scale (NOS). RevMan5.1software was used to conduct the meta-analysis.ResultSection1:Mortality rate between the2groups did not show statistically significant differences (P=0.27). The evacuation rate was significantly higher in the NE group compared to the craniotomy group (P=0.02), and the rate of infection was lower in the NE group compared to the craniotomy group (P=0.04). Operation time (P＜0.00001) and mean NICU stay (P=0.005) were significantly shorter in the NE group than in the craniotomy group. Patients in the NE group had good functional outcomes (GFO) than patients in the craniotomy group (P=0.04).Section2:Eleven trials (5RCTs and6ORs) involving680patients were included. The odds ratio (OR) showed a statistically significant difference between the NE+EVD and EVD+IVF groups in terms of mortality (OR,0.31;95%CI,0.16-0.59; P=0.0004), effective hematoma evacuation rate (OR,25.50,95%CI;14.30,45.45; P＜0.00001), good functional outcome (GFO)(OR,4.51;(95%CI,2.81-7.72; P＜0.00001), and the ventriculo-peritoneal (VP) shunt dependence rate (OR,0.16;95%CI;0.06,0.40; P＜0.0001).ConclusionsSection1: The results indicated NE surgery is an effective and safe approach for hypertensive intracerebral hemorrhage, and it is also suggested NE may promote a good functional recovery. However, NE approach only suit to the selected patient, and the usefulness of NE approach needs further RCTs to evaluate.Section2:Applying neuroendoscopic approach with EVD may be a better management for IVH secondary to spontaneous supratentorial hemorrhage than NE+IVF. However, there is still no concluive evidence regarding the preference of NE vs. EVD alone in the case of IVH, because insufficient data has been published thus far. This study suggests that the NE approach with EVD could become an alternative to EVD+IVF for IVH in the future.