Efficacy Comparison of Neuroendoscopic Surgery versus Stereotactic Aspiration for Brain Hemorrhage
Overview
This retrospective study compared neuroendoscopic surgery (NS) and stereotactic aspiration (SA) in 199 patients with intraparenchymal hemorrhage (IPH). NS demonstrated significantly higher hematoma evacuation rates, greater early neurological improvement, and lower rates of symptomatic rebleeding and 30-day mortality across various brain hemorrhage locations.
Background
Intraparenchymal hemorrhage (IPH) is a severe form of stroke with high mortality and morbidity, involving cerebral, cerebellar, and brainstem regions. Minimally invasive surgical techniques such as neuroendoscopic surgery (NS) and stereotactic aspiration (SA) are increasingly used to manage IPH. NS allows direct visualization and active hemostasis, while SA uses image-guided catheter aspiration, often with thrombolytics. Comparative data on their effectiveness across different anatomical hemorrhage locations remain limited.
Data Highlights
Outcome
Neuroendoscopic Surgery (NS)
Stereotactic Aspiration (SA)
p-value
Median Hematoma Reduction Rate (%)
92.90
22.20
<0.001
Median ΔGCS at 24h
4.0 points
0.5 points
<0.001
Functional Independence (mRS 0–3) at Discharge
27.8%
15.7%
0.040
Symptomatic Rebleeding
7.2%
24.5%
<0.001
30-day Mortality
9.3%
22.5%
0.012
Key Findings
NS achieved a significantly higher median hematoma evacuation rate (92.9%) compared to SA (22.2%).
Patients treated with NS showed greater acute neurological improvement, with a median GCS increase of 4 points versus 0.5 points for SA.
Functional independence at discharge was more frequent in the NS group (27.8%) than in the SA group (15.7%).
NS was associated with significantly lower symptomatic rebleeding rates (7.2% vs. 24.5%).
Thirty-day mortality was significantly reduced in the NS group (9.3%) compared to SA (22.5%).
These benefits of NS were consistent across different IPH locations including deep-seated, lobar, cerebellar, and brainstem hemorrhages.
Clinical Implications
Neuroendoscopic surgery offers superior hematoma evacuation and early neurological recovery compared to stereotactic aspiration across various brain hemorrhage locations. Its association with lower rebleeding and mortality rates suggests it may be the preferred minimally invasive approach when feasible. Clinicians should consider NS especially in patients suitable for direct visualization and active hemostasis to optimize early outcomes.
Conclusion
This study highlights the potential advantages of neuroendoscopic surgery over stereotactic aspiration in managing intraparenchymal hemorrhages across different anatomical sites. Prospective studies are needed to validate these findings and assess long-term functional outcomes.
References
Renmin Hospital of Wuhan University, 2019-2023 -- Retrospective Analysis of NS vs. SA in IPH
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