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Updated: Jun 24, 2025
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Minimally invasive surgeries for spontaneous hypertensive intracerebral hemorrhage (MISICH): a multicenter randomized
Xinghua Xu1, Huaping Zhang2, Jiashu Zhang3
1Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China. dr_xxh@126.com.
Insights
Minimally invasive surgeries like endoscopic surgery and stereotactic aspiration improve outcomes for intracerebral hemorrhage (ICH) patients compared to craniotomy. These methods are particularly effective for deep hemorrhages, offering better functional recovery.
Area of Science:
- Neurosurgery
- Neurology
- Stroke Medicine
Background:
- Intracerebral hemorrhage (ICH) is a significant cause of stroke-related disability and death.
- Current surgical treatments for ICH lack a definitively superior method.
- This study compares minimally invasive techniques against traditional craniotomy for supratentorial ICH.
Purpose of the Study:
- To evaluate the efficacy of endoscopic surgery and stereotactic aspiration versus small-bone flap craniotomy.
- To determine if minimally invasive approaches improve functional outcomes in patients with supratentorial ICH.
- To compare the effectiveness of different surgical interventions for hypertensive ICH.
Main Methods:
- A parallel-group, multicenter randomized controlled trial involving 721 patients with supratentorial hypertensive ICH.
- Patients were randomized (1:1:1) to undergo endoscopic surgery, stereotactic aspiration, or small-bone flap craniotomy.
- The primary outcome was a favorable functional outcome (modified Rankin Scale score 0-2) at 6-month follow-up.
Main Results:
- Endoscopic surgery (33.3%) and stereotactic aspiration (32.7%) showed significantly higher rates of favorable functional outcomes compared to craniotomy (22.2%) (P=.017).
- Minimally invasive techniques were especially beneficial for deep ICH, while outcomes were similar for lobar hemorrhages.
- Craniotomy was associated with higher hospitalization costs compared to stereotactic aspiration.
Conclusions:
- Endoscopic surgery and stereotactic aspiration offer improved long-term functional outcomes for hypertensive ICH patients compared to small bone flap craniotomy.
- These minimally invasive methods are particularly advantageous for treating deep ICH.
- The findings support the use of minimally invasive surgical techniques for specific ICH cases.
Background:
Intracerebral hemorrhage (ICH) is a common stroke type with high morbidity and mortality. There are mainly three surgical methods for treating ICH. Unfortunately, thus far, no specific surgical method has been proven to be the most effective. We carried out this study to investigate whether minimally invasive surgeries with endoscopic surgery or stereotactic aspiration (frameless navigated aspiration) will improve functional outcomes in patients with supratentorial ICH compared with small-bone flap craniotomy.
Methods:
In this parallel-group multicenter randomized controlled trial conducted at 16 centers, patients with supratentorial hypertensive ICH were randomized to receive endoscopic surgery, stereotactic aspiration, or craniotomy at a 1:1:1 ratio from July 2016 to June 2022. The follow-up duration was 6 months. Patients were randomized to receive endoscopic evacuation, stereotactic aspiration, or small-bone flap craniotomy. The primary outcome was favorable functional outcome, defined as the proportion of patients who achieved a modified Rankin scale (mRS) score of 0-2 at the 6-month follow-up.
Results:
A total of 733 patients were randomly allocated to three groups: 243 to the endoscopy group, 247 to the aspiration group, and 243 to the craniotomy group. Finally, 721 patients (239 in the endoscopy group, 246 in the aspiration group, and 236 in the craniotomy group) received treatment and were included in the intention-to-treat analysis. Primary efficacy analysis revealed that 73 of 219 (33.3%) in the endoscopy group, 72 of 220 (32.7%) in the aspiration group, and 47 of 212 (22.2%) in the craniotomy group achieved favorable functional outcome at the 6-month follow-up (P = .017). We got similar results in subgroup analysis of deep hemorrhages, while in lobar hemorrhages the prognostic outcome was similar among three groups. Old age, deep hematoma location, large hematoma volume, low preoperative GCS score, craniotomy, and intracranial infection were associated with greater odds of unfavorable outcomes. The mean hospitalization expenses were ¥92,420 in the endoscopy group, ¥77,351 in the aspiration group, and ¥100,947 in the craniotomy group (P = .000).
Conclusions:
Compared with small bone flap craniotomy, endoscopic surgery and stereotactic aspiration improved the long-term outcome of hypertensive ICH, especially deep hemorrhages.
Trial Registration:
ClinicalTrials.gov Identifier: NCT02811614.
