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International Journal of Stroke 18(5)
Table 2. Clinical results after propensity score matching.
ES (n = 53)
Duration of surgerya, min
Blood lossa, ml
Postoperative hematomab, ml
Clearance rateb, %
Rebleeding, No. (%)
Infectious meningitis, No. (%)
Pulmonary infection, No. (%)
Epilepsy, No. (%)
Post-cerebral infarction, No. (%)
ICU stayb, days
Hospital stayb, days
Mortality rate (30 days), No. (%)
GOS score, No. (%)
1-3
4-5
143.9 ± 48.9
151.3 ± 87.4
4.0 (1.5, 7.8)
93.3 (88.3, 97.1)
0 (0.0%)
6 (11.3%)
48 (90.6%)
9 (17.0%)
2 (3.8%)
5.0 (3.0, 12.0)
23.0 (18.0, 37.0)
4 (7.6%)
33 (62.3%)
20 (37.7%)
OS (n = 106)
192.1 ± 66.5
p
0.000
342.5 ± 234.9
5.9 (2.8, 14.2)
88.7 (72.2, 95.6)
8 (7.6%)
12 (11.3%)
102 (96.2%)
18 (17.0%)
5 (4.7%)
8.0 (5.0, 15.0)
34.5 (21.0, 46.8)
14 (13.2%)
84 (79.3%)
22 (20.8%)
GOS: Glasgow Outcome Scale; ICU: intensive care unit; ES: endoscopic surgery; OS: open surgery.
aValues are mean ± standard deviation (SD).
bValues are median (interquartile range).
multivariable modified Poisson regression analysis similarly
demonstrated that ES was associated with a better outcome
(RR = 1.75; 95% CI = 1.05-2.91, p = 0.034). We
further adjusted for propensity score and the relationship
remained stable (RR = 1.96; 95% CI = 1.14-3.37, p = 0.017).
Moreover, we weighted IPTW in univariable modified
Poisson regression analysis, and the RR was also similar
(RR = 2.05; 95% CI = 1.24-3.39, p = 0.006). Similarly, the
RR of weighted SMRW model, weighted PA model, and
weighted OW model were also stable (Table 3).
Discussion
The goal of our study was to identify the safety and effectiveness
of ES for life-threatening large supratentorial ICH
with pre-GCS score ⩽8. Our results showed that ES significantly
shortened operation time, increased the hematoma
evacuation rate, shortened the length of stay in ICU
and hospital, and had a higher incidence of favorable outcome
in the sixth month after surgery in these patients.
Hemorrhagic stroke remains a leading cause of death
and disability worldwide. Unlike infratentorial cerebellar
hemorrhage, which definitely benefits from surgical intervention,20-23
whether supratentorial spontaneous ICH can
International Journal of Stroke, 18(5)
benefit from surgical treatment remains controversial.24-26
The space-occupying effect caused by the hematoma itself
and PHE lead to the increase of ICP.27 In the process of
hematoma degradation, a series of pro-inflammatory reactions
are induced, which eventually leads to cell apoptosis,
degradation, self-phagocytosis, and destruction of bloodbrain
barrier.28,29 So in theory, the surgical hematoma evacuation
would help to alleviate mass effect and reduce
cytotoxic reaction and PHE.
Direct hematoma evacuation with open technique
remains the most commonly used method in large-volume
ICH because the hematoma regions can be exhaustively
exposed with this method. However, this method also brings
relatively serious brain injury, which may neutralize its benefits.
In order to reduce the iatrogenic injury caused by
hematoma clearance, the minimally invasive surgery gains
increased popularity in ICH, which mainly includes stereotactic
aspiration (SA) and ES. ES allows for satisfactory
hemostasis under endoscopic view and rapid alleviation of
mass effect. Many studies verified the superiority of ES
over the craniotomy and conservative treatment in decreasing
mortality, poor outcomes, and specific complications of
moderate-volume and large-volume hematoma.6-9,11,12,20,30
Our research suggested that ES was also suited for large,
life-threatening hemorrhage with preoperative GCS score
0.000
0.036
0.013
0.040
1.000
0.275
1.000
0.726
0.018
0.014
0.288
0.022
WSO - June 2023

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