Short-term efficacy of stereotactic-guided neuroendoscopic hematoma clearance via the forehead keyhole approach in treatment of hypertensive basal ganglia hemorrhage

Abstract

Objective To investigate the short-term efficacy of stereotactic-guided neuroendoscopic hematoma clearance via the forehead keyhole approach in the treatment of hypertensive basal ganglia hemorrhage (HBGH). Methods A total of 148 patients with HBGH who were treated in Department of Neurosurgery in our hospital from December 2016 to August 2021 were enrolled and divided into study group and control group according to their surgical plans. The 74 patients who underwent conventional stereotactic hematoma puncture and drainage were enrolled as control group, and the 74 patients who underwent stereotactic-guided neuroendoscopic hematoma clearance via the forehead keyhole approach were enrolled as study group. The two groups were compared in terms of time of operation, the proportion of patients with rebleeding during hospitalization, the proportion of patients with hematoma clearance at 6 hours after surgery, European Stroke Scale (ESS) score and Barthel index before surgery and at 3 months after surgery, the proportion of deaths at 3 months after surgery, the proportion of patients with complications at 3 months after surgery, and the proportion of patients with good prognosis at 6 months after surgery. Results Compared with the control group, the study group had a significantly longer time of operation (t=19.084,P<0.05) and a significantly lower proportion of patients with rebleeding during hospitalization (χ2=9.378,P<0.05). The study group had a significantly higher hematoma clearance rate than the control group at 6 hours after surgery (u=2.935,P<0.05); at 3 months after surgery, the study group had significantly higher difference before and after surgery ESS score and Barthel index than the control group (t=8.349,9.474,P<0.05), while there were no significant differences in mortality rate and the incidence rate of complications between the two groups (P>0.05); at 6 months after surgery, compared with the control group, the study group had a significantly higher proportion of patients with good prognosis (χ2=9.483,P<0.05). Conclusion Although stereotactic-guided neuroendoscopic hematoma clea-rance via the forehead keyhole approach has a relatively long time of operation in the treatment of HBGH, it can improve hematoma clearance rate, reduce postoperative rebleeding rate, and help to achieve a good prognosis; meanwhile, it can also improve the neurological function and living ability of patients, with a favorable safety profile.

Keywords

• intracranial hemorrhage, hypertensive|stereotaxic techniques|neuroendoscopy|hematoma|forehead|treatment outcome|prognosis