Curative Effect of Neuroendoscopic Evacuation of Hematoma Through Different Approaches on Patients with Hypertensive Intracerebral Hemorrhage

ZHANG Bin; MA Xuhui; ZHENG Pengfei

doi:10.3969/j.issn.1004-437X.2025.03.010

Abstract：Objective To explore the curative effect of neuroendoscopic evacuation of hematoma through different approaches on patients with hypertensive intracerebral hemorrhage(HICH).Methods A retrospective analysis was performed on the clinical data of 80 patients with HICH undergoing evacuation of hematoma from June 2020 to October 2022.According to surgical approaches,they were divided into transtemporal approach group(38 cases)and transfrontal approach group(42 cases).The perioperative indexes in the two groups were compared.The severity of neurological impairment was compared by National Institutes of Health stroke scale(NIHSS)before surgery,at 7 and 14 days after surgery.The biochemical indexes[tumor necrosis factor a(TNF-a),C-reactive protein(CRP),neuron-specific enolase(NSE)]and cerebral hemodynamics indexes[mean blood flow(Q),mean velocity(V),systole peripheral resistance of bilateral common cerebral artery(R)]before and after surgery,scores of Glasgow outcome scale(GOS)at 1 month after surgery and postoperative complications in the two groups were compared.Results After surgery,there were no differences in operation time and intraoperative blood loss between the two groups(P＞0.05).The hematoma clearance rate in transfrontal approach group was higher than that in transtemporal approach group(P＜0.05),and removal time of drainage tube was shorter than that in transtemporal approach group(P＜0.05).The groups,time points and interaction of NIHSS scores between the two groups were significant(P＜0.05),and the NIHSS scores at 7 days and 14 days after the observation group were lower than that of the control group(P＜0.05).After surgery,levels of TNF-α,CRP and NSE in transfrontal approach group were lower than those in transtemporal approach group(P＜0.05).R in transfrontal approach group was lower than that in transtemporal approach group(P＜0.05),while Q and V were higher than those in transtemporal approach group(P＜0.05).The GOS scores in transfrontal approach group was better than that in transtemporal approach group(P＜0.05).There was no significant difference in the total incidence of complications between the two groups(P＞0.05).Conclusion Compared with transtemporal approach,transfrontal approach can better improve hematoma clearance rate,shorten extubation time,improve cerebral hemodynamics,reduce inflammatory response and cerebral nerve injury,and improve prognosis in HICH patients,with certain safety.