Comparative Study Of Neuroendoscopic Surgery And Craniotomy For Hypertensive Intracerebral Hemorrhage

Objective: Spontaneous hypertensive intracerebral hemorrhage is a destructive disease with high incidence and high mortality,which is characterized by high cost of treatment and poor prognosis.Currently,choosing traditional craniotomy or neuroendoscopic surgery still remains controversial when hypertensive intracerebral hemorrhage reaches the requirement of the surgery.Up to now,traditional craniotomy is a comparatively mature method of surgical treatment,but the distraction and injury of certain brain issue will inevitably appear when removing intracranial hematoma,and may have some influence on prognosis.In recent years,the endoscopic surgery is being operated for the removal of intracranial hematoma.With the feature of short operative time,small trauma and good prognosis,this therapeutic method can effectively remove intracranial hematoma and decrease the damage to normal brain tissues.Compared with the traditional craniotomy,the technology of endoscopic neurosurgery is now receiving increasing attention.In this study,retrospective analysis on the clinical indicators was conducted in patients with hypertensive intracerebral hemorrhage who underwent the endoscopic neurosurgery and craniotomy in our department.Exploring the effect and result of the two different surgical approaches on the objective indexes of patients with spontaneous hypertension during and after surgery can provide a theoretical basis for choosing a proper and rational clinical treatment of spontaneous hypertensive intracerebral hemorrhage.Method: Patients with hypertensive basal ganglia hemorrhage who received treatment in Neurosurgery Department I of The Second Hospital of Jilin University from January 2014 to December 2016 was investigated,and 41 patients who needed the treatment for hypertensive basal ganglia hemorrhage were selected divided into two groups.Group A(n = 21)underwent neuroendoscopic surgery,Group B(n = 20)underwent craniotomy.Before the surgery,collected the preoperative general information including age and sex and recorded the disease situation including preoperative systolic,GCS scoring,preoperative amount of bleeding;When in surgery,calculated the blood loss and kept the record of the operation time;Measured the residual blood volume and calculated the hematoma clearance rate after the surgery.Recorded patients' hospitalization days after discharging,proceeded the statistical analysis of complications occurred,and then calculated mortality based on the data collected via telephone follow-up 1 months after the operation.The ability of daily life(ADL)shall be recorded separately 3 months and 6 months after the surgery.SPSS 22.0 was used to analyze and compare if there is any difference between the two groups from the below aspects: the preoperative general information,the operative time,intraoperative blood loss,hematoma clearance rate,complication occurrence rate,mortality and prognosis.Based on the analysis and comparison result,the effect of two surgical approaches in removing hypertensive intracerebral hemorrhage was evaluated.Results: The preoperative general information of patients in two groups was consisted of age,sex,preoperative amount of bleeding,systolic pressure,GCS scoring.And there was no statistically significant differences of the clinical data between the two groups(P>0.05),which showed that the preoperative situation of selected patients were same,so the comparability existed in two groups.The operation time of neuroendoscopic surgery was shorter(P<0.05)than that of craniotomy.And blood loss was also much less(P<0.05)in neuroendoscopic surgery when compared with craniotomy.The average hospitalization time was comparatively shorter of neuroendoscopic surgery than that of craniotomy with statistical significance(P<0.05).From the perspective of the effect of hematoma removal,there was no statistically significant difference between two groups(P>0.05).In neuroendoscopic surgery,the complication occurrence rate(33.33%)was lower than that of craniotomy(40 %).One month later after discharging from the hospital,one patient who underwent neuroendoscopic surgery died with the morality rate of 4.76%;while 2 deaths occurred in craniotomy group with the morality of 10%.The morality in neuroendoscopic surgery was lower than that in craniotomy.However,there was no statistically significant difference between the complication occurrence rate and mortality of two groups.In terms of the prognosis,three and six months later after operation,the ADL of neurosurgical surgery were both higher than that of craniotomy,which relatively had the statistically significance(P<0.05).Conclusion: 1.In the treatment of hypertensive basal ganglia hemorrhage,the endoscopic surgery costs less time,causes less blood loss and small damage to brain tissue than that of craniotomy.2.Neuroendoscopic surgery is a minimal invasive surgery,It has a shorter average postoperative hospital stay and a better long-term prognosis than Craniotomy.It is worthy of further promotion.