Comparison Between Stereotactic Aspiration and Intra-endoscopic Surgery to Treat Intracerebral Hemorrhage
Comparison Between Stereotactic Aspiration and Intra-endoscopic Surgery to Treat Intracerebral Hemorrhage
Views for surgery method selection of intracerebral hemorrhage are still controversial. Since
 the application of neuroendoscopic technique in intraventricular hemorrhage was confirmed
 effective and safe, some investigators have attempted to use endoscopic strategies to
 evacuate intracerebral hematomas. Some significant advances have also been reported in
 endoscopic hematoma evacuation when compared to conventional craniotomy. However, it is still
 crucial to implement a prospective and controlled study to evaluate the efficiency and safety
 of endoscopic technique in the treatment of intracerebral hemorrhage. In this study, the
 investigators will exclusively select some patients with intracerebral hemorrhage in the
 basal ganglia region. This study will compare the efficacy and safety of endoscopic surgery
 versus stereotactic aspiration on neurologic outcomes for patients with intracerebral
 hemorrhage.
Although the incidence and mortality of spontaneous intracerebral hemorrhage (ICH) have been
 decreased with the improved management of high blood pressure, ICH may induce serious
 disability for the patients and continue to be a major socioeconomic problem. The evacuation
 of ICH using open craniotomy or computer tomography (CT)-guided stereotaxy may improve the
 survival rate of these patients but failed to prove efficacy in improving patients'
 functional outcome despite numerous efforts. Endoscopy-guided evacuation of ICH provides a
 less invasive and quicker surgical decompression, which may potentially improve the
 functional outcome for patients. In previous studies, endoscope-guided evacuation of ICH is
 often referred to as that an endoscope only provides an illuminating system while the
 operating channel is independent from the endoscope (endoscopy-controlled microneurosurgery
 or endoscopy-assisted microneurosurgery). In recent years, authors have been committed to
 explore the procedure of intra-endoscopy-guided evacuation of ICH, which means that the
 illuminating channel, the irrigation-aspiration channel and the working channel are all
 located in the endoscope. This kind of procedure can be called as real endoscopic
 neurosurgery (EN), which may potentially decrease the operative concomitant injuries at the
 most extent. However, the inherent drawbacks of intra-endoscopic procedures, including the
 limited visualization of the surgical field and the difficult maintenance of patency of the
 aspiration wand, can offset the advantages in some instances. The authors exclusively
 invented a special endoscopic transparent sheath for guiding hematoma puncture and an
 agitation-aspiration system (AAS) for keeping patency of the aspiration wand. Detailed
 procedures of their application will be implemented and verified in a series of patients with
 intracerebral hemorrhage. Meanwhile, the mortality rate, complications and other outcome
 parameters between this procedure and CT-guided procedures will be compared.
Inclusion Criteria:

 -  primary basal ganglion region intracerebral hemorrhage

 -  older than 18 years

 -  admitted within 6 h after onset of ICH

 Exclusion Criteria:

 -  other type of ICH than acute primary intracerebral hemorrhage

 -  patients who need neurosurgery

 -  life expectancy less than 3 months due to comorbid disorders

 -  confirmed malignant disease (cancer)

 -  confirmed acute myocardial infarction

 -  hepatitis and/liver cirrhosis

 -  renal failure

 -  infectious disease (HIV, endocarditis etc.)

 -  current or previous hematologic disease

 -  women of childbearing age if pregnant

 -  participation in another study within the preceding 30 days