Surgery for Coagulopathy-Related Intracerebral Hemorrhage: Craniotomy vs. Minimally Invasive Neurosurgery
Yen-Bo Liu,
Lu-Ting Kuo,
Chih-Hao Chen,
Woon-Man Kung,
Hsin-Hsi Tsai,
Sheng-Chieh Chou,
Shih-Hung Yang,
Kuo-Chuan Wang,
Dar-Ming Lai,
Abel Po-Hao Huang
Affiliations
Yen-Bo Liu
Department of Surgery, Division of Neurosurgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
Lu-Ting Kuo
Department of Surgery, Division of Neurosurgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
Chih-Hao Chen
Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
Woon-Man Kung
Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei 11114, Taiwan
Hsin-Hsi Tsai
Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
Sheng-Chieh Chou
Department of Internal Medicine, Division of Hematology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
Shih-Hung Yang
Department of Surgery, Division of Neurosurgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
Kuo-Chuan Wang
Department of Surgery, Division of Neurosurgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
Dar-Ming Lai
Department of Surgery, Division of Neurosurgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
Abel Po-Hao Huang
Department of Surgery, Division of Neurosurgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
Coagulopathy-related intracerebral hemorrhage (ICH) is life-threatening. Recent studies have shown promising results with minimally invasive neurosurgery (MIN) in the reduction of mortality and improvement of functional outcomes, but no published data have recorded the safety and efficacy of MIN for coagulopathy-related ICH. Seventy-five coagulopathy-related ICH patients were retrospectively reviewed to compare the surgical outcomes between craniotomy (n = 52) and MIN (n = 23). Postoperative rebleeding rates, morbidity rates, and mortality at 1 month were analyzed. Postoperative Glasgow Outcome Scale Extended (GOSE) and modified Rankin Scale (mRS) scores at 1 year were assessed for functional outcomes. Morbidity, mortality, and rebleeding rates were all lower in the MIN group than the craniotomy group (8.70% vs. 30.77%, 8.70% vs. 19.23%, and 4.35% vs. 23.08%, respectively). The 1-year GOSE score was significantly higher in the MIN group than the craniotomy group (3.96 ± 1.55 vs. 3.10 ± 1.59, p = 0.027). Multivariable logistic regression analysis also revealed that MIN contributed to improved GOSE (estimate: 0.99650, p = 0.0148) and mRS scores (estimate: −0.72849, p = 0.0427) at 1 year. MIN, with low complication rates and improved long-term functional outcome, is feasible and favorable for coagulopathy-related ICH. This promising result should be validated in a large-scale prospective study.
