PDF icon PDF herunterladen
Open Access
CC BY-NC-ND 4.0 · Asian J Neurosurg 2025; 20(03): 478-484
DOI: 10.1055/s-0045-1809166
Review Article

Conventional Craniotomy and Neuroendoscopic Surgery for Patients with Hypertensive Intracerebral Hemorrhage: A Meta-analysis and Systematic Review

John Emmanuel Y. Custodio
1   Section of Neurosurgery, Department of Surgery, Jose R. Reyes Memorial Medical Center, Santa Cruz, Manila, Philippines
,
Joseph Erroll V. Navarro
1   Section of Neurosurgery, Department of Surgery, Jose R. Reyes Memorial Medical Center, Santa Cruz, Manila, Philippines
,
Oliver Ryan M. Malilay
1   Section of Neurosurgery, Department of Surgery, Jose R. Reyes Memorial Medical Center, Santa Cruz, Manila, Philippines
› Institutsangaben
› Weitere Informationen
Auch verfügbar aufeRef
  Lizenzen und Reprints
Preview

Abstract

Primary spontaneous Intracerebral Hemorrhage (PSICH) is a devastating disease occurring in 24.6 cases per 100,000 people per year, more common with chronic arterial hypertension. Emergent hematoma evacuation remains a lifesaving intervention especially in younger patients with large hematoma volume and are clinically deteriorating. Timely and appropriate management is key to improving outcomes. In this study, we compared whether conventional craniotomy or neuroendoscopic surgery would lead to improved mortality and better functional outcomes in patients with PSICH. Specifically, we wanted to determine the extent of hematoma clearance, intraoperative blood loss, intraoperative time, degree of rebleeding, total complications, and length of hospital stay among the surgical approaches utilized. We searched from the Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE/PubMed, the U.S. National Institutes of Health Ongoing Trials Register, Embase database, Health Research and Development Information Network (HERDIN), and the World Health Organization International Clinical Trials Registry Platform for studies to be included. Patients with deep hypertensive intracerebral hemorrhage of either sex, aged 18 to 60 years, with a Glasgow Coma Score of 6 to 12, with hematoma volume of 30 to 80 mL, and received treatment within 24 hours with either conventional craniotomy or neuroendoscopic surgery were allowed. Outcomes evaluated were mortality and functional outcome. The risk of bias was assessed using the ROBINS-I tool for nonrandomized studies. The final search yielded four eligible studies. Both conventional craniotomy and neuroendoscopic surgery did not show any statistically significant difference in postoperative mortality (risk ratio [RR]: 1.32, 95% confidence interval [CI]: 0.48–3.62, p = 0.59, I2: 42%) and postoperative functional outcome (RR: 3.17, 95% CI: 0.76–13.3, p = 0.11, I2: 83%). Neuroendoscopic surgery showed statistically significant shorter operative time. Both interventions yielded similar results in amount of volume evacuated, intraoperative blood loss, length of hospital stay, number of rebleeding, and total complications. This meta-analysis and review shows that conventional craniotomy and neuroendoscopic surgery both lead to good postoperative functional outcomes with similar death rates. Neuroendoscopic surgery showed statistically significant shorter operative time. Both interventions result in high volume of hematoma evacuated, low number of rebleeding, and total complications, as well as similar amount of intraoperative blood loss and length of hospital stay.

Keywords

conventional craniotomy - intracerebral hemorrhage - neuroendoscopic surgery - neurosurgery - spontaneous


Publikationsverlauf

Artikel online veröffentlicht:
20. Mai 2025

© 2025. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India