Minimally-invasive Surgery Versus Craniotomy in Patients With Supratentorial Hypertensive Intracerebral Hemorrhage
Minimally-invasive Surgery Versus Craniotomy in Patients With Supratentorial Hypertensive Intracerebral Hemorrhage
The effectiveness of craniotomy in the treatment of intracerebral hemorrhage remains
 controversial. Two main types of minimally invasive surgery, endoscopic evacuation and
 stereotactic aspiration, have been attempted for hematoma removal and show some advantages.
 However, prospective and controlled studies are still lacking. This is a multi-center
 randomized controlled trial designed to determine whether minimally invasive surgeries will
 improve the outcome in patients with hypertensive intracerebral hemorrhage compared with
 craniotomy. Patients will be randomly assigned to endoscopy group, stereotactic aspiration
 group and craniotomy group in a 1:1:1 ratio.
Hypertensive intracerebral hemorrhage (HICH) is the most common hemorrhagic stroke. The
 morbidity and mortality exceed 60% and only 12% patients could live independently. The choice
 of surgical or conservative treatment for patients with HICH is controversial.

 Some minimally invasive neurosurgeries have been applied to hematoma evacuation and may
 improve prognosis to some extent. In endoscopic evacuation, a small burr hole is created and
 hematoma is removed through suction and irrigation under neuroendoscope. Endoscopic surgical
 evacuation promise to maximize hematoma evacuation while minimizing damage to normal tissue.
 Stereotactic aspiration uses image guidance to place a catheter into the main body of the
 hematoma and aspirate blood. In this study, about 900 patients will receive endoscopic
 evacuation, stereotactic aspiration or craniotomy according to the results of randomization.
 Patients will be followed up at 7 days, 30 days and 6 months.

 Outcomes of different groups of patients will be collected and compared. The study is
 designed to find a best surgical method for hypertensive intracerebral hemorrhage.
Inclusion Criteria:

 -  Supratentorial hypertensive intracerebral hemorrhage on CT scan with the hematoma
 volume >20mL

 -  Adult patients with GCS score ≥5

 -  Admitted within 24h of ictus

 Exclusion Criteria:

 -  Intracerebral hemorrhage caused by tumor, coagulopathy, aneurysm, or arteriovenous
 malformation

 -  Concurrent head injury or history of head injury

 -  Multiple intracerebral hemorrhage

 -  Known advanced demential or disability before

 -  With indications of terminal brain hernia

 -  Severe concomitant diseases that affect life expectancy

 -  Patients having taken anti-platelet or anticoagulant drugs for a long time

 -  With severe intraventricular hemorrhage

 -  Pregnant women