Effectiveness of Surgical Treatments for Basal Ganglia Hemorrhage and Imaging Factors Affecting Hematoma Evacuation Rate by Neuroendoscopic Surgery

Abstract

Background Basal ganglia hemorrhage (BGH) is a devastating neurologic disease with high morbidity and mortality, and its management is still controversial. We evaluated the effectiveness of surgical treatments for BGH and investigated computed tomography (CT) imaging features affecting the hematoma evacuation rate (ER) in patients treated with neuroendoscopic surgery.

Materials and Methods A total of 104 BGH patients who underwent craniotomy, burr-hole drainage, or neuroendoscopic surgery were analyzed retrospectively. Clinical characteristics, imaging features, and postoperative complications were compared. Univariate and multivariate regression analyses were applied to identify imaging factors associated with ER.

Results A significant difference in ER was observed: 78.4% in patients treated with neuroendoscopic surgery, 33.6% in patients treated with burr-hole drainage, and 82.5% in patients treated with craniotomy (p < 0.001). Similar results were observed for operative time (p < 0.001). Five cases (12.5%) of rebleeding were found in patients treated with burr-hole drainage (p = 0.020). No significant difference was found for pneumonia, intracranial infection, gastrointestinal bleeding, hospital mortality, hospital stay, expenses, 3-day Glasgow Coma Scale (GCS) scores after surgery, or GCS at discharge. The CT imaging feature, the island sign (p = 0.004), was observed as an independent factor correlated with lower ER for neuroendoscopic surgery.

Conclusions The benefits and drawbacks of surgical treatments confirmed they have their own indications, and neuroendoscopic surgery may be relatively beneficial for BGH treatment. The island sign was an independent factor affecting ER for neuroendoscopic surgery. Therefore, comprehensive assessment of clinical data, especially the island sign, should be performed preoperatively in BGH patients.

Keywords

basal ganglia hemorrhage - intracerebral hemorrhage - hematoma evacuation rate - neuroendoscopic surgery - island sign

^∗ The authors contributed equally to this paper.

• References

• 1 Morgenstern LB, Hemphill III JC, Anderson C. , et al; American Heart Association Stroke Council and Council on Cardiovascular Nursing. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2010; 41 (09) 2108-2129
• 2 Cai Q, Zhang W, Ji B, Ding X, Chen Z, Chen Q. Basal ganglion hematoma evacuation and clipping of middle cerebral artery aneurysm by neuroendoscopy: a case report. Medicine (Baltimore) 2018; 97 (18) e0606
• 3 Gong C, Boulis N, Qian J, Turner DE, Hoff JT, Keep RF. Intracerebral hemorrhage-induced neuronal death. Neurosurgery 2001; 48 (04) 875-882 ; discussion 882–883
• 4 Gebel Jr JM, Jauch EC, Brott TG. , et al. Natural history of perihematomal edema in patients with hyperacute spontaneous intracerebral hemorrhage. Stroke 2002; 33 (11) 2631-2635
• 5 Huang FP, Xi G, Keep RF, Hua Y, Nemoianu A, Hoff JT. Brain edema after experimental intracerebral hemorrhage: role of hemoglobin degradation products. J Neurosurg 2002; 96 (02) 287-293
• 6 Zazulia AR, Diringer MN, Derdeyn CP, Powers WJ. Progression of mass effect after intracerebral hemorrhage. Stroke 1999; 30 (06) 1167-1173
• 7 Prasad K, Mendelow AD, Gregson B. Surgery for primary supratentorial intracerebral haemorrhage. Cochrane Database Syst Rev 2008; (04) CD000200
• 8 Zheng J, Li H, Zhao HX. , et al. Surgery for patients with spontaneous deep supratentorial intracerebral hemorrhage: a retrospective case-control study using propensity score matching. Medicine (Baltimore) 2016; 95 (11) e3024
• 9 Kim SH, Kim JS, Kim HY, Lee SI. Transsylvian-transinsular approach for deep-seated basal ganglia hemorrhage: an experience at a single institution. J Cerebrovasc Endovasc Neurosurg 2015; 17 (02) 85-92
• 10 Zhou X, Chen J, Li Q. , et al. Minimally invasive surgery for spontaneous supratentorial intracerebral hemorrhage: a meta-analysis of randomized controlled trials. Stroke 2012; 43 (11) 2923-2930
• 11 Vespa PM, Martin N, Zuccarello M, Awad I, Hanley DF. Surgical trials in intracerebral hemorrhage. Stroke 2013; 44 (06) (Suppl. 01) S79-S82
• 12 Chen CH, Lee HC, Chuang HC. , et al. Transsylvian-transinsular approach for the removal of basal ganglia hemorrhage under a Modified Intracerebral Hemorrhage score. J Craniofac Surg 2013; 24 (04) 1388-1392
• 13 Zhang Y, Ding W, Yang Y, Xu H, Xiong F, Liu C. Effects of transsylvian-transinsular approach to hypertensive putaminal hematoma operation and electroacupuncture on motor recovery. J Craniofac Surg 2011; 22 (05) 1626-1630
• 14 Sun H, Liu H, Li D, Liu L, Yang J, Wang W. An effective treatment for cerebral hemorrhage: minimally invasive craniopuncture combined with urokinase infusion therapy. Neurol Res 2010; 32 (04) 371-377
• 15 Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM. ; STICH II Investigators. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet 2013; 382 (9890): 397-408
• 16 Mendelow AD, Gregson BA, Fernandes HM. , et al; STICH investigators. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet 2005; 365 (9457): 387-397
• 17 Deinsberger W, Lang C, Hornig C, Boeker DK. Stereotactic aspiration and fibrinolysis of spontaneous supratentorial intracerebral hematomas versus conservative treatment: a matched-pair study. Zentralbl Neurochir 2003; 64 (04) 145-150
• 18 Auer LM, Deinsberger W, Niederkorn K. , et al. Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. J Neurosurg 1989; 70 (04) 530-535
• 19 Hemphill JC. 3rd, Greenberg SM, Anderson CS. , et al; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2015; 46 (07) 2032-2060
• 20 Steiner T, Al-Shahi Salman R, Beer R. , et al; European Stroke Organisation. European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke 2014; 9 (07) 840-855
• 21 Xia Z, Wu X, Li J. , et al. Minimally invasive surgery is superior to conventional craniotomy in patients with spontaneous supratentorial intracerebral hemorrhage: a systematic review and meta-analysis. World Neurosurg 2018; 115: 266-273
• 22 Li Q, Yang CH, Xu JG, Li H, You C. Surgical treatment for large spontaneous basal ganglia hemorrhage: retrospective analysis of 253 cases. Br J Neurosurg 2013; 27 (05) 617-621
• 23 Zhang HZ, Li YP, Yan ZC. , et al. Endoscopic evacuation of basal ganglia hemorrhage via keyhole approach using an adjustable cannula in comparison with craniotomy. BioMed Res Int 2014; 2014: 898762
• 24 Cai Q, Zhang H, Zhao D. , et al. Analysis of three surgical treatments for spontaneous supratentorial intracerebral hemorrhage. Medicine (Baltimore) 2017; 96 (43) e8435
• 25 Xu X, Chen X, Li F. , et al. Effectiveness of endoscopic surgery for supratentorial hypertensive intracerebral hemorrhage: a comparison with craniotomy. J Neurosurg 2018; 128 (02) 553-559
• 26 Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg 2006; 203 (06) 865-877
• 27 Wang T, Guan Y, Du J, Liu G, Gao F, Zhao X. Factors affecting the evacuation rate of intracerebral hemorrhage in basal ganglia treated by minimally invasive craniopuncture. Clin Neurol Neurosurg 2015; 134: 104-109
• 28 Yao Z, Hu X, You C, He M. Effect and feasibility of endoscopic surgery in spontaneous intracerebral hemorrhage: a systematic review and meta-analysis. World Neurosurg 2018; 113: 348-356.e2
• 29 Li Z, Li Y, Xu F, Zhang X, Tian Q, Li L. Minimal invasive puncture and drainage versus endoscopic surgery for spontaneous intracerebral hemorrhage in basal ganglia. Neuropsychiatr Dis Treat 2017; 13: 213-219
• 30 Feng Y, He J, Liu B, Yang L, Wang Y. Endoscope-assisted keyhole technique for hypertensive cerebral hemorrhage in elderly patients: a randomized controlled study in 184 patients. Turk Neurosurg 2016; 26 (01) 84-89
• 31 Wang WH, Hung YC, Hsu SP. , et al. Endoscopic hematoma evacuation in patients with spontaneous supratentorial intracerebral hemorrhage. J Chin Med Assoc 2015; 78 (02) 101-107
• 32 Beynon C, Schiebel P, Bösel J, Unterberg AW, Orakcioglu B. Minimally invasive endoscopic surgery for treatment of spontaneous intracerebral haematomas. Neurosurg Rev 2015; 38 (03) 421-428 ; discussion 428
• 33 Li Y, Yang R, Li Z. , et al. Surgical evacuation of spontaneous supratentorial lobar intracerebral hemorrhage: comparison of safety and efficacy of stereotactic aspiration, endoscopic surgery, and craniotomy. World Neurosurg 2017; 105: 332-340
• 34 Yamashiro S, Hitoshi Y, Yoshida A, Kuratsu J. Effectiveness of endoscopic surgery for comatose patients with large supratentorial intracerebral hemorrhages. Neurol Med Chir (Tokyo) 2015; 55 (11) 819-823
• 35 Li Q, Liu QJ, Yang WS. , et al. Island sign: an imaging predictor for early hematoma expansion and poor outcome in patients with intracerebral hemorrhage. Stroke 2017; 48 (11) 3019-3025