Minimally invasive surgery approaches, including endoscopic evacuation and stereotactic aspiration, show some improvements in outcomes of supratentorial hypertensive intracerebral haemorrhage (HICH), compared with surgical craniotomy, according to a study presented here at the 2019 Annual Meeting of the American Association of Neurological Surgeons (AANS).

"Compared with craniotomy, endoscopic evacuation and stereotactic aspiration might enhance the neurological recovery in patients with supratentorial HICH and improve the outcomes," said first author Xinghua Xu, MD, National Clinical Research Center for Aging and Medicine, Chinese PLA General Hospital, Beijing, China.

For the study, the researchers analysed outcomes form 113 patients with supratentorial HICH who were randomized treatment with endoscopy (n=37), stereotactic aspiration (n=37) or craniotomy (n=39).

Mean surgery times in the endoscopic and aspiration groups were 1.6 hours and 1.2 hours, respectively, compared with 4.6 hours in the craniotomy group (P = .001). Mean blood loss was 53 mL and 22 mL in the endoscopic and aspiration groups, while it was substantially higher -- 385 mL -- in the craniotomy group (P

Haematoma clearance rates were 89.8% in the endoscopic group, 51.3% in the drainage group, and 87.6% in the craniotomy group (P< .001).

The Glasgow Coma Scale (GCS) score at discharge was 12.5 in the endoscopic group, 12.1 in the aspiration group, and 10.3 in the craniotomy group (P = .001).

No differences were seen in terms of intracranial infections and in-hospital mortality.

Favourable outcomes (assessed by modified Rankins Score) were reported in 39% of patients in the endoscopic group, in 37% of patients in the aspiration group, and in 27% of patients in the craniotomy group.

In terms of complications, the incidence rates of stroke-related pneumonia were 30% in the endoscopic group, 27% in the aspiration group, and 49% in the craniotomy group, which was not statistically significant (P = .093), although Dr. Xu noted that was likely due to the small sample size.

"Compared with traditional craniotomy, endoscopic surgery and stereotactic aspiration had less injury to the patient, could reduce haemorrhage-related complications, and patients could recover more quickly," said Dr. Xu. "Minimally invasive surgeries have the potential to improve the prognosis of patients with intracerebral haemorrhage."

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