Results of open and endoscopy-guided removal of hypertensive intracerebral hematomas

The objective is to compare the effectiveness of surgical treatment of the patients with hypertensive intracerebral hematomas (ICH) using endoscopic aspiration and craniotomy removal.

Materials and methods. Analysis of the results of surgical treatment of 132 patients with ICH. Patients of group I (n = 72) underwent craniotomy removal of ICH, group II (n = 60) underwent endoscopic intervention. Endoscopic ICH aspiration was performed using surgical navigation system and ventriculoscope (outer diameter – 6.5 mm, operating length – 13 cm, luminal area of the working channel – 20 mm2), with a high light-transmitting capacity.

Results. Death rate in the patients over the age of 71 after endoscopic intervention was significantly lower than after craniotomy removal (45.4 and 86 %, respectively). In patients with soporose condition, death rate after open removal was 86.4 %, and after endoscopic aspiration – 44 %; in patients with wakefulness reduced to coma this indicator was 100 and 75 %, respectively. Death rate in the patients with thalamic ICH was 20 % after endoscopic intervention and 83.3 % after open surgery, with putaminal ICH – 39.5 and 50 %, respectively, with subcortical ICH – 22.7 and 0 %. Among patients with a hematoma with volume of up to 40 ml, death rate was 17.2 and 4.7 % in the groups I and II, respectively, with volume from 61 to 100 ml – 81.8 and 66.7 %.

Conclusion. After endoscopy-guided removal of ICH the number of patients with good recovery increased 3-fold, and the post-operative mortality decreased by 19 %. The use of endoscopic technique in the treatment of hypertensive ICH under the control of neuronavigation (in comparison with open craniotomy removal and microsurgical ICH evacuation) improved the results of treatment due to decreasing of mortality rate and improvement of functional outcomes of the disease.

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