Comparison of keyhole endoscopy and craniotomy for the treatment of patients with hypertensive cerebral hemorrhage

By comparing the intraoperative and postoperative conditions under different surgical methods, namely, keyhole endoscopy and craniotomy, we aim to provide more reasonable surgical treatment for patients with hypertensive cerebral hemorrhage. Eighty-nine patients with cerebral hemorrhage at Rizhao People's Hospital between January 2015 and December 2016 were analyzed retrospectively. Patients were assigned to the keyhole endoscopy group and the craniotomy group. The intraoperative (the duration of operation, operative blood transfusion and loss, and hematoma clearance rate) and the postoperative parameters (death rate, rebleeding rate, edema, and postoperative activity of daily living [ADL] scores) of the 2 groups were compared. Compared with the craniotomy group, the keyhole endoscopy group exhibited decreases in mean blood loss (P < .05, 180 ± 13.6 mL vs 812 ± 35.2 mL), blood transfusion (P < .05, 0 mL vs 480 ± 13.6 mL), the average surgical duration of operation (P < .05, 113 ± 14.3 minutes vs 231 ± 26.1 minutes), and the severe edema rate (P < .05, 10.9% vs 72.1%) and increases in the average hematoma clearance rate (P < .05, 95.6% vs 82.3%) and postoperative ADL scores (P < .05, 85.2% vs 39.0%). Neither the death rate (P > .05, 4.3% vs 4.7%) nor rebleeding rate (P > .05, 2.2% vs 2.3%) showed any obvious changes. Keyhole endoscopy for the treatment of hypertensive intracerebral hemorrhage has the advantages of minimal trauma with good effects, and its main reason for short operation time, reduced bleeding, and high hematoma clearance rate is the “brain-hematoma” pressure gradient. Use of the intraoperative micropull technique and removal of intracerebral hematoma in the shortest time possible are critical factors contributing to the high ADL scores in the keyhole endoscopy group. However, further validation on a larger sample size is required.