Comparison of endoscopic evacuation, stereotactic aspiration, and craniotomy for treatment of basal ganglia hemorrhage

J Neurointerv Surg. 2020 Jan;12(1):55-61. doi: 10.1136/neurintsurg-2019-014962. Epub 2019 Jul 12.

Abstract

Background: The main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques.

Objective: To explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage.

Methods: Five hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes.

Results: For the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40-<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551).

Conclusion: Endoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.

Keywords: basal ganglia hemorrhage; craniotomy; minimally invasive surgical procedures; neuroendoscopy; retrospective studies; treatment outcome.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Basal Ganglia Hemorrhage / diagnostic imaging*
  • Basal Ganglia Hemorrhage / mortality
  • Basal Ganglia Hemorrhage / surgery*
  • Cohort Studies
  • Craniotomy / methods*
  • Craniotomy / mortality
  • Female
  • Humans
  • Imaging, Three-Dimensional / methods
  • Imaging, Three-Dimensional / mortality
  • Male
  • Middle Aged
  • Neuroendoscopy / methods*
  • Neuroendoscopy / mortality
  • Paracentesis / methods*
  • Paracentesis / mortality
  • Retrospective Studies
  • Stereotaxic Techniques* / mortality
  • Treatment Outcome