Title: A Comparative Study between Endoscope-assisted and Craniotomy Evacuation in Spontaneous Intracerebral Hematoma
Authors: Dr Mst. Shamima Sultana, Dr Md. Shafiqul Islam, Dr Md. Sumon Rana, Dr Kanij Fatema Ishrat Zahan Rifat, Dr Monsur Ahmed, Dr Abul Kalam Azad, Prof. Kanak Kanti Barua
Introduction: Although, Intracerebral hemorrhage (ICH) accounts for only 10% to 15% of all strokes but it is a common disease with an incidence ranging from 11 to 23 cases per 100,000 per year. This study was done to determine and compare the functional outcome of patients with spontaneous intra-cerebral hemorrhage (ICH) by modified Rankin scale (mRS), treated by endoscope-assisted evacuation with that of craniotomy. This study also aims to find out the hematoma evacuation rate, operating time and improvement of Glasgow Coma scale (GCS) in both groups and to compare it.
Materials and Methods: We have studied 40 patients of spontaneous ICH diagnosed by non-contrast CT (Computed Tomography) scan of brain. In 20 patient’s endoscope-assisted hematoma evacuation and in another 20 patients craniotomy evacuation was done. Follow up CT scan was done within 24 hrs of surgery to compare with pre-operative scan. Data were analyzed by demographic variable (age, sex), clinical (GCS at admission, on 3rd postoperative day and at discharge), radiological (side, location, and volume of hematoma), hematoma evacuation rate and operating time. Follow up was done at 3 months and outcome was measured by modified Rankin scale (mRS).
Results: The mean (SD- Standard Deviation) age of endoscope-assisted group and craniotomy group was found 57.9(9.9) years and 52.2(11.7) years respectively. Male sex was predominant. Hematoma was located in ganglio-thalamic region in 9(45%) patients and lobar in 11(55%) patients in endoscope-assisted group. In 8(40%) patients hematoma was located in ganglio-thalamic region and 12(60%) patients in lobar in craniotomy group. Majority of study patients had hematoma on left side. Surgery was done within 48 hrs from the onset of symptoms. Four patients (20%) were died from endoscope-assisted group and seven patients (35%) died from craniotomy group. There was no statistically significant difference (p > 0.05) between two groups regarding age, sex, location of hematoma, improvement in GCS and mortality rate. Mean operating time was 1.23(0.47) hrs in endoscope-assisted group and 2.15(0.56) hrs in craniotomy group. Hematoma evacuation rate was better in endoscope-assisted group 74(11) % than in craniotomy group 65(13) %. There was statistically significant difference regarding operating time, hematoma evacuation rate and outcome in both groups (p <0.05).
Conclusion: This study revealed that endoscope-assisted procedure has better outcome and hematoma evacuation rate than craniotomy.
Keywords: Intracerebral hemorrhage, modified Rankin scale, Glasgow Coma scale, Hematoma evacuation rate, endoscope-assisted group.