Background: Intracerebral hemorrhage (ICH) is a serious medical condition associated with high mortality and disability rates. Surgical interventions, including neuroendoscopic surgery (NES) and craniotomy, are employed to manage ICH and improve patient outcomes. This meta-analysis compared the effectiveness of NES versus craniotomy in treating ICH.
Methods: A systematic literature search was conducted to identify relevant studies comparing NES with craniotomy for ICH. Inclusion criteria encompassed primary or secondary results from randomized controlled trials or observational studies for confirmed supratentorial ICH. Data were extracted, and methodological quality was assessed using appropriate tools. Statistical analysis was performed using meta-analysis software.
Results: The analysis included 26studies (N = 3237 patients). NES was associated with significantly lower mortality compared with craniotomy (odds ratio 0.45, 95% confidence interval [CI] 0.33 to 0.60, P < 0.00001). Hematoma evacuation rates were higher with NES (standardized mean difference 1.505, 95% CI 0.835 to 2.160, P < 0.00001). NES also showed better functional outcomes (odds ratio 3.31, 95% CI 1.78 to 6.17, P = 0.0002) and reduced blood loss (standardized mean difference -3.06, 95% CI -3.979 to -2.141, P = 0.000). Additionally, NES was associated with shorter hospital and intensive care unit stays, shorter operative times, and fewer complications such as infection and rebleeding.
Conclusions: NES is a promising alternative to craniotomy for treating ICH, offering advantages in terms of reduced mortality, improved functional outcomes, and fewer complications. Future studies should explore advances in neuroendoscopic techniques to optimize patient outcomes further.
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http://dx.doi.org/10.1016/j.wneu.2024.07.212 | DOI Listing |
Cureus
December 2024
Pharmacology and Therapeutics, Lake Erie College of Osteopathic Medicine, Elmira, USA.
Traumatic brain injuries (TBIs) represent a spectrum of neurological conditions resulting from external forces impacting the head, leading to temporary or permanent impairments in cognitive, emotional, or physical functioning. Acute subdural hematomas (ASDH) are a significant subset of TBIs characterized by the rupture of blood vessels within the subdural space between the brain and the dura mater. Management of ASDH typically involves two primary surgical procedures: craniectomy and craniotomy.
View Article and Find Full Text PDFNeurosurgery
December 2024
Department of Occupational Medicine, Kaiser Permanente, Los Angeles, California, USA.
Neurosurgery
December 2024
Department of Anesthesiology, Hospital Fundación Santa Fe de Bogotá, Bogotá, Colombia.
Surg Neurol Int
November 2024
Research Center, Almoosa Health Group, Al-Ahsa, Saudi Arabia.
Background: Chronic subdural hematoma (CSDH) is a prevalent neurological disorder, especially among the elderly, where blood accumulates between the brain and its outer covering. The primary treatment for CSDH involves surgical intervention, such as burr-hole craniotomy, with or without irrigation of the subdural space. The efficacy of irrigation versus no irrigation in reducing recurrence, mortality, and postoperative complications remains debated.
View Article and Find Full Text PDFSurg Neurol Int
November 2024
Department of Neurosurgery, Sana Klinikum, Lichtenberg, Berlin, Germany.
Background: Cerebellar infarction can lead to severe morbidity and mortality. Current surgical options include decompressive craniectomy (DC) and endoscopic minimally invasive evacuation of necrotic tissue (MEN), but no randomized studies compare their outcomes.This study compares outcomes between DC and MEN in patients with cerebellar infarct using the Glasgow Coma Scale (GCS) and Scale for the Assessment and Rating of Ataxia (SARA) scores.
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