Age-stratified analysis of the outcomes of craniotomy versus minimally invasive surgery in patients with spontaneous intracerebral hemorrhage

Abstract

Background: Spontaneous intracerebral hemorrhage (ICH) results in severe neurological deficits. Currently, the primary surgical interventions for ICH are traditional craniotomy and minimally invasive surgery (MIS).

Aim: This study was conducted to compare surgical outcomes between craniotomy and MIS in age-stratified patients.

Methods: This retrospective study included patients with spontaneous ICH undergoing craniotomy or MIS between January 2013 and December 2018. The diagnosis of ICH was confirmed by head computed tomography. We included patients with ICH in the subcortical, putamen, or thalamic region with volume >15 mL. We excluded patients with secondary ICH due to tumors or vascular lesions, those with coagulopathy and using anticoagulants. The selected patients were stratified by age into younger (<65 years) and older (≥65 years) groups.

Results: The study cohort comprised 169 patients. The younger and older groups included 105 (62 %) and 64 (38 %) patients, respectively. Craniotomy and MIS were performed in 55 and 50 patients in the younger and 37 and 27 patients in the older group, respectively. Between-group comparisons revealed significant age-based differences in Glasgow Coma Scale (GCS) scores 1 and 6 months after surgery (p = 0.0067 and p = 0.0001) and Glasgow Outcome Scale (GOS) scores 6 months after surgery (p = 0.0372). In the older group, 6-month GOS scores were significantly lower for patients undergoing craniotomy (p = 0.0332).

Conclusion: Hemorrhagic stroke carries high risks of mortality and morbidity. Age is a crucial factor that influences recovery. MIS yields favorable outcomes and should be prioritized for spontaneous ICH, particularly older patients.

Keywords: Craniotomy; Elderly; Minimally invasive surgery; Spontaneous intracerebral hemorrhage.