Endoscopic surgery for hemorrhagic stroke in regional vascular centers

The study objective is to analyze surgical outcomes in patients with hemorrhagic stroke treated by endoscopic aspiration in five regional vascular centers in Russia and to evaluate capabilities and benefits of this surgical procedure. Material and methods. The study included 296 patients with hemorrhagic stroke (with various locations of the hemorrhage) that underwent endoscopic aspiration between 2006 and 2018 at one of the following institutions: N.V. Sklifosovsky Research Institute for Emergency Medicine (Moscow), City Clinical Emergency Hospital No. 1 (Omsk), Regional Clinical Hospital (Yaroslavl), N.A. Semashko Republic Clinical Hospital (Simferopol), Irkutsk Regional Clinical Hospital. Neurosurgery departments of these healthcare institutions are the parts of regional vascular centers. We used Glasgow Outcome Scale to evaluate outcomes of surgical treatment. Results. Complete recovery was observed in 52 (17.5 %) patients, while 52 (17.5 %) patients developed moderate disability and 131 patients (44.5 %) developed severe disability. Four (1.5 %) patients developed a vegetative state. Fifty-seven (19 %) patients died after surgery. Conclusion. The experience of treating hemorrhagic stroke in five neurosurgical centers demonstrates that endoscopic aspiration of hypertensive intracerebral hemorrhages is in no way inferior to microsurgery. It ensures satisfactory results and can be used in patients with various hemorrhages.

1. Kandel E.I., Peresedov V.V. Stereotactic removal of intracranial hematomas. Zhurnal “Voprosy neirokhirurgii im. N.N. Burdenko” = Problems of Neurosurgery n. a. N.N. Burdenko 1987;51(3):6–21.(In Russ.)

2. Krylov V.V., Dashyan V.G., Shetova I.M. et al. Neurosurgical care for patients with cerebrovascular pathology in Russian Federation. Neyrokhirurgiya = Russian Journal of Neurosurgery 2017;(4):11–20. (In Russ.)

3. Krylov V.V., Byrov S.A., Galankina I.E., Dashyan V.G. Local fibrinolysis in the surgery of intracranial hemorrhages. Neyrokhirurgiya = Russian Journal of Neurosurgery 2006;(3):4–12. (In Russ.)

4. Saribekyan A.S., Polyakova L.N. The results of surgical treatment of patients with hypertensive intracerebral hematomas by puncture/aspiration method in combination with local fibrinolysis prourokinase. Zhurnal “Voprosy neirokhirurgii im. N.N. Burdenko” = Problems of Neurosurgery n. a. N.N. Burdenko 2003;(3):8–11. (In Russ.)

5. Dashian V.G., Murashko A.A., Korshikova A.N., Krylov V.V. Videoendoscopy in surgery of hemorrhagic stroke. Neyrokhirurgiya = Russian Journal of Neurosurgery 2012;(2):17–26.(In Russ.)

6. Krylov V.V., Konovalov A.N., Dashyan V.G. et al. The current state of neurosurgery in Russian Federation. Neyrokhirurgiya = Russian Journal of Neurosurgery 2016;(3):3–44. (In Russ.)

7. Svyatochevsky P.A., Gulyaev D.A., Burmistrova A.V. Analysis of results of treatment of hypertensive intracerebral hematomas in the Chuvash Republic. Rossiyskiy neyrokhirurgicheskiy zhurnal im. A.L. Polenova = Russian Neurosurgical Journal n. a. A.L. Polenov 2018;10(special issue):220. (In Russ.)

8. Teasdale G., Murray G., Parker L., Jennett B. Adding up the Glasgow Coma Score. Acta Neurochir Suppl(Wien) 1979;28(1):13–6. PMID: 290137.

9. Jennett B., Snoek J., Bond M.R., Brooks N. Disability after severe head injury: observations on the use of the Glasgow Outcome Scale. J Neurol Neurosurg Psy 1981;44(4):285–93. PMID: 6453957.

10. Li Y., Yang R., Li Z. et al. Surgical evacuation of spontaneous supratentorial lobar intracerebral hemorrhage: comparison of safety and efficacy of stereotactic aspiration, endoscopic surgery, and craniotomy. World Neurosurg 2017;105:332–40. DOI: 10.1016/j.wneu.2017.05.134. PMID: 28578111.

11. Nievas M.C., Toktamis Y.S., Haas E., Höllerhage H.G. Benefits of adapting minimal invasive techniques to selected patients with spontaneous supratentorial intracerebral hematomas. Neurol Res 2005;27(7):755–61. DOI: 10.1179/016164105X35620. PMID: 16197813.

12. Cho D.Y., Chen C.C., Chang C.S. et al. Endoscopic surgery for spontaneous basal ganglia hemorrhage: comparing endoscopic surgery, stereotactic aspiration, and craniotomy in noncomatose patients. Surg Neurol 2006;65(6):547–55. DOI: 10.1016/j.surneu.2005.09.032. PMID: 16720167.

13. Cho D.Y., Chen C.C., Lee H.C. et al. Glasgow Coma Scale and hematoma volume as criteria for treatment of putamenal and thalamic intracerebral hemorrhage. Surg Neurol 2008;70(6):628–33. DOI: 10.1016/j.surneu.2007.08.006. PMID: 18207500.

14. Dashyan V.G., Sytnik V., Godkov I.M. Results of endoscopic and open surgery of putaminal hematomas. Rossiyskiy neyrokhirurgicheskiy zhurnal im. A.L. Polenova = Russian Neurosurgical Journal n. a. A.L. Polenov 2016;8(1):12–18. (In Russ.)

15. Shesterikov Ya.A., Petrosyan К.G., Pospelov E.N. et al. Results of open and endoscopy-guided removal of hypertensive intracerebral hematomas. Neyrokhirurgiya = Russian Journal of Neurosurgery 2018;20(2):50–7. (In Russ.)

16. Orakcioglu B., Beynon C., Bösel J. et al. Minimally invasive endoscopic surgery for treatment of spontaneous intracerebral hematomas: a single-center analysis. Neurocrit Care 2014;21(3):407–16. DOI: 10.1007/s12028-014-9987-6. PMID: 24805008.