Evaluation of three minimally invasive surgical techniques for hematoma removal in elderly patients with hypertensive intracerebral hemorrhage: A pilot randomized study

Abstract

Objective: To compare the efficacy and safety of three minimally invasive surgical (MIS) techniques— neuroendoscopic hematoma removal, minimally invasive soft channel puncture and drainage, and small bone window microhematoma removal—in elderly patients with hypertensive cerebral hemorrhage.

Methods: A total of 60 elderly patients with hypertensive cerebral hemorrhage were randomly assigned to one of three groups: neuroendoscopic hematoma removal (n=20), minimally invasive soft channel puncture and drainage (n=20), and small bone window microhematoma removal (n=20). Operative parameters (surgical time, intraoperative bleeding), postoperative complications, and long-term neurological outcomes (National Institutes of Health Stroke Scale -- NIHSS and Glasgow Outcome Scale -- GOS scores) were assessed and compared among the groups.

Results: Neuroendoscopic hematoma removal was associated with significantly shorter surgical times (141.3±14.9 minutes) and reduced intraoperative bleeding (119.4±22.1 ml) compared to the other techniques (P<0.01). Postoperative complication rates were lower in the neuroendoscopic group (1.59%) compared to the small bone window (30%) and soft channel groups (15%) (P<0.05). Long-term outcomes, measured by NIHSS and GOS scores, were significantly better in the neuroendoscopic group, indicating improved neurological recovery and functional status (P<0.01).

Conclusion: Neuroendoscopic hematoma removal may offer significant advantages over small bone window microhematoma removal and minimally invasive soft channel puncture and drainage in terms of operative efficiency, reduced complications, and improved long-term neurological outcomes. These findings should be validated in future large sample-sized, multi-center, randomized trials.