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Neuroendoscopic versus Craniotomy Approach in Supratentorial Hypertensive Intracerebral Hemorrhage: An Updated
Abdul Haseeb1, Muhammad Ashir Shafique1, Muhammad Saqlain Mustafa1
1Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan.
Insights
Neuroendoscopic surgery (NES) offers a safer and more effective treatment for intracerebral hemorrhage (ICH) compared to craniotomy. This surgical approach significantly reduces mortality, improves patient outcomes, and leads to fewer complications.
Area of Science:
- Neurosurgery
- Minimally Invasive Procedures
- Neurological Surgery
Background:
- Intracerebral hemorrhage (ICH) presents significant mortality and disability risks.
- Current surgical options for ICH include neuroendoscopic surgery (NES) and craniotomy.
- Comparative effectiveness of these surgical methods for ICH requires further investigation.
Purpose of the Study:
- To compare the effectiveness of neuroendoscopic surgery (NES) versus craniotomy for treating intracerebral hemorrhage (ICH).
- To evaluate differences in mortality, hematoma evacuation, functional outcomes, and complications between NES and craniotomy.
Main Methods:
- A systematic literature search identified studies comparing NES and craniotomy for supratentorial ICH.
- Included were randomized controlled trials and observational studies.
- Meta-analysis was employed to statistically compare outcomes.
Main Results:
- NES was associated with significantly lower mortality (OR 0.45, P < 0.00001) and higher hematoma evacuation rates (SMD 1.505, P < 0.00001).
- Improved functional outcomes (OR 3.31, P = 0.0002) and reduced blood loss (SMD -3.06, P = 0.000) were observed with NES.
- NES also demonstrated shorter hospital/ICU stays, reduced operative times, and fewer complications.
Conclusions:
- Neuroendoscopic surgery (NES) is a viable and advantageous alternative to craniotomy for ICH management.
- NES offers benefits including reduced mortality, enhanced functional recovery, and a lower complication profile.
- Further research into advanced neuroendoscopic techniques can optimize patient outcomes for ICH.
Background:
Intracerebral hemorrhage (ICH) is a serious medical condition associated with high mortality and disability rates. Surgical interventions, including neuroendoscopic surgery (NES) and craniotomy, are employed to manage ICH and improve patient outcomes. This meta-analysis compared the effectiveness of NES versus craniotomy in treating ICH.
Methods:
A systematic literature search was conducted to identify relevant studies comparing NES with craniotomy for ICH. Inclusion criteria encompassed primary or secondary results from randomized controlled trials or observational studies for confirmed supratentorial ICH. Data were extracted, and methodological quality was assessed using appropriate tools. Statistical analysis was performed using meta-analysis software.
Results:
The analysis included 26studies (N = 3237 patients). NES was associated with significantly lower mortality compared with craniotomy (odds ratio 0.45, 95% confidence interval [CI] 0.33 to 0.60, P < 0.00001). Hematoma evacuation rates were higher with NES (standardized mean difference 1.505, 95% CI 0.835 to 2.160, P < 0.00001). NES also showed better functional outcomes (odds ratio 3.31, 95% CI 1.78 to 6.17, P = 0.0002) and reduced blood loss (standardized mean difference -3.06, 95% CI -3.979 to -2.141, P = 0.000). Additionally, NES was associated with shorter hospital and intensive care unit stays, shorter operative times, and fewer complications such as infection and rebleeding.
Conclusions:
NES is a promising alternative to craniotomy for treating ICH, offering advantages in terms of reduced mortality, improved functional outcomes, and fewer complications. Future studies should explore advances in neuroendoscopic techniques to optimize patient outcomes further.
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