Endoscopic-assisted keyhole technique for hypertensive cerebral hemorrhage in elderly patients: a randomized controlled study in 184 patients

The keyhole technique is a new minimally invasive surgical approach, and became a new trend in neurosurgery.Even if the indications for surgical drainage are still controversial, the criteria for the choice of a drainage technique are even less well established.Several groups developed minimally invasive clot removal techniques (2,6,13,18).In this present study, we focused on elderly patients with a surgical indication for hematoma drainage, and who were █ InTRODuCTIOnIn the neurosurgical emergency ward, hypertensive cerebral hemorrhage (HCH) is a common occurrence.Among cases of sudden stroke-related neurological deficits, spontaneous supratentorial intracerebral hemorrhage is common in Asians, has the highest morbidity and mortality, and accounts for 20% of all stroke cases.Risk factors for HCH increase dramatically with age (9).AIM: Hypertensive cerebral hemorrhage (HCH) is a potentially life-threatening cerebrovascular disease with high mortality.In case of a massive hematoma, surgical drainage is a crucial treatment.The aim of the present study was to assess the efficacy of the endoscope-assisted keyhole technique in elderly patients with intracerebral hematoma who needed a flap craniotomy as traditional treatment.MATERIAl and METhODS: One hundred-eighty-four elderly patients with HCH, who had craniotomy indications after conservative treatment for 6-24 hours after onset, were randomly divided into two groups.In the craniotomy group, traditional hematoma drainage was performed.In the keyhole group, an endoscope-assisted keyhole technique was used.Anesthesia time, blood loss, hematoma drainage rate, and complications were compared.The clinical primary outcome was the six-month efficacy rate (defined by the activities of daily living (aDl) score).RESulTS: Anesthesia time was longer in the craniotomy group (3.43±0.65 vs. 1.53±0.52h, P<0.01), and blood losses were more important (256±129 vs. 96±39 ml P<0.01).There was no difference in hematoma drainage rate between the two groups (77.25±13.44 vs. 83.52±27.51%P>0.05).Complications, including tracheotomy (P<0.01),pulmonary infection (P<0.01) and hypoproteinemia (P<0.05) were more frequent in the craniotomy group.There was no difference in the occurrence of other complications, including revision surgery digestive tract ulcer and epilepsy.proportion of patients with good prognosis (aDl I-III) was larger in the keyhole group (P<0.05). COnCluSIOn:In elderly HCH patients with an indication for hematoma drainage, better outcomes were achieved using an endoscope-assisted keyhole technique.