The efficacy of three different approaches in treatment of hypertensive intracerebral hemorrhage: a multi-center single-blind study of 2464 patients
ZHAO Ji-zong*, ZHOU Ding-biao, ZHOU Liang-fu, WANG Ren-zhi, WANG De-jiang, WANG Shuo, YUAN Ge, KANG Shuai, ZHAO Yuan-li, JI Nan, YE Xun.*Department of Neurosurgery, Beijing Tiantan Hospital, Capital University of Medical Sciences, Beijing 100050,China
Objective To compare the efficacy and indications of the 3 approaches: conventional open craniotomy (COC), computed- tomography guided aspiration (CTGA), and key-hole approach (KHA) in neurosurgical management for hypertensive intracerebral hemorrhage (HICH). Methods The clinical data of HICH 2464 patients, aged 14-75, operated on within 24 hours after stroke, with a Glasgow coma score ≥5, hospitalized in 135 hospitals all over the mainland of China, were collected and underwent single-blind study. Results Among the 2464 patients 639 underwent COC, 1416 underwent CTGA, and 409 were operated on via KHA. The overall mortality rates within one and three months after operation were 19.3% and 21.1% respectively. The mortality rate within 3 months after operation (M3m) of the patient with a GCS≤8 was 3.5 times as much as the M3m of the patients with a GCS≥8. The M3m of the patients with complications was 4.4 times as much as that of the patients without complications. The M3m of the patients with hemorrhage in thalamus was 2.4 times as much as that of the patients with cortical hemorrhage. The M3m of the COC group was 24.6%, higher than those of the KHA group (17.6%) and CTGA group (20,6%). The postoperative complication rate of the COC group was 29.9%, significantly higher than that of the CTGA group (24.8%, P=0.015). There were no significant differences in postoperative complication rate between the COC and KHA groups and between the CTGA and KHA groups (both P005). Conclusion KHA and CTGA are both better than COC in treatment of HICH with more favorable outcome and less postoperative mortality and morbidity.