J Cerebrovasc Endovasc Neurosurg.  2020 Sep;22(3):156-164. 10.7461/jcen.2020.22.3.156.

Surgical strategy for patients with supratentorial spontaneous intracerebral hemorrhage: minimally invasive surgery and conventional surgery

• Jang JH
• Cho WS
• Hong N
• Pang CH
• Lee SH
• Kang HS
• Kim JE

• KMID: 2506762
• DOI: http://doi.org/10.7461/jcen.2020.22.3.156

Abstract

Objective
The role of surgery in spontaneous intracerebral hemorrhage (sICH) is still controversial. We aimed to investigate the effectiveness of minimally invasive surgery (MIS) compared to conventional surgery (CS) for supratentorial sICH.
Methods
The medical data of 70 patients with surgically treated supratentorial sICH were retrospectively reviewed. MIS was performed in 35 patients, and CS was performed in 35 patients. The surgical technique was selected based on the neurological status and radiological findings, such as hematoma volume, neurological status and spot signs on computed tomographic angiography. Treatment outcomes, prognostic factors and the usefulness of the spot sign were analyzed.
Results
Clinical states in both groups were statistically similar, preoperatively, and in 1 and 3 months after surgery. Both groups showed significant progressive improvement till 3 months after surgery. Better preoperative neurological status, more hematoma removal and intensive care unit (ICU) stay ≤7 days were the significant prognostic factors for favorable 3-month clinical outcomes (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.10-0.96, p=0.04; OR 1.04, 95% CI 1.01-1.08, p=0.02; OR 26.31, 95% CI 2.46-280.95, p=0.01, respectively). Initial hematoma volume and MIS were significant prognostic factors for a short ICU stay (≤7 days; OR 0.95; 95% CI 0.91-0.99; p=0.01; OR 3.91, 95% CI 1.03-14.82, p=0.045, respectively). No patients in the MIS group experienced hematoma expansion before surgery or postoperative rebleeding.
Conclusions
MIS was not inferior to CS in terms of clinical outcomes. The spot sign seems to be an effective radiological marker for predicting hematoma expansion and determining the surgical technique.

Keyword

Conventional surgery; Intracerebral hemorrhage; Minimally invasive surgery; Spot sign; Treatment outcome

Figure

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  Fig. 1 Flow diagram showing the patient selection process. ICH, intracerebral hemorrhage.

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  Fig. 2 Comparison of clinical states with the modified Rankin Scale between the minimally invasive surgery (MIS) and conventional surgery (CS) groups preoperatively as well as 1 and 3 months postoperatively.

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  Fig. 3 Comparison of the aspirated hematoma volume from minimally invasive surgery among different operation times from symptom onset.

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