Endoscopic surgery for spontaneous basal ganglia hemorrhage: comparing endoscopic surgery, stereotactic aspiration, and craniotomy in noncomatose patients

Abstract

Background: This prospective study aimed to evaluate the safety, neurological outcomes, and cost-effectiveness of 3 surgical procedures for spontaneous basal ganglia hemorrhage.

Methods: Ninety noncomatose patients with basal ganglia hemorrhages were randomized into 3 groups. Group A (n = 30) underwent endoscopic surgery, group B (n = 30) underwent stereotactic aspiration, and group C (n = 30) underwent craniotomy. Waiting time of surgery, length of operation time, and blood loss were compared between all groups. On the second operative day, we evaluated the amount of residual hematoma and the hematoma evacuation rate by computed tomography scan. Surgical mortality and complications were recorded 3 months after the procedure. Neurological outcomes were evaluated by functional independence measure (FIM) score, Barthel index score, and muscle power (MP) of affected limbs 6 months after surgery. We also evaluated the cost-effectiveness of each procedure.

Results: There was significant delay in waiting timing of the stereotactic aspiration (172.56 +/- 93.18 minutes; P < .001). Craniotomy had the longest operation time (229.96 +/- 50.57 minutes; P < .001). Blood loss was most significant in the craniotomy (236.13 +/- 137.45 mL; P < .001). The highest hematoma evacuation rate was seen in the endoscopic surgery (87% +/- 8%; P < .01). The mortality rate was 0% in group A, 6.7% in group B, and 13.3% in group C (P = .21). The complication rate was 3.3% in group A, 10% in group B, and 16.6% in group C (P = .62). The most major complications were rebleeding and infection. The FIM score was higher in the endoscopic surgery (79.90 +/- 36.64) than in the craniotomy (33.84 +/- 18.99; P = .001). The Barthel index score was also significantly better in the endoscopic surgery (50.45 +/- 28.59) than in the craniotomy (16.39 +/- 20.93; P = .006). There was more improvement in MP of affected limbs in endoscopic surgery than in craniotomy (P = .004). Endoscopic surgery was more cost-effective than craniotomy using FIM and Barthel index (P < .02 and P < .05, respectively).

Conclusions: Both endoscopic surgery and stereotactic aspiration are minimally invasive and are effective procedures with low complication and mortality rates; however, the waiting timing of stereotactic aspiration is usually longer. Endoscopic surgery may be an appropriate substitute for stereotactic aspiration. It produces good neurological outcomes and aids in rapid hematoma evacuation. Craniotomy may be used for emergency decompression of enlarged hematoma if endoscopic surgery or stereotactic aspiration is not available.