Multimodal image fusion-assisted endoscopic evacuation of spontaneous intracerebral hemorrhage

Chao Zhang; Juan Li; Ping-Li Wang; Hua-Yun Chen; Yu-Hang Zhao; Ning Wang; Zhi-Tao Zhang; Yan-Wei Dang; Hong-Quan Wang; Jun Wang; Chu-Hua Fu

doi:10.1016/j.cjtee.2024.03.006

Multimodal image fusion-assisted endoscopic evacuation of spontaneous intracerebral hemorrhage

Chin J Traumatol. 2024 Mar 16:S1008-1275(24)00033-6. doi: 10.1016/j.cjtee.2024.03.006. Online ahead of print.

Authors

Affiliations

¹ Department of Neurosurgery, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, 441000, Hubei province, China.
² Department of Ophthalmology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, 441000, Hubei province, China.
³ Department of Neurosurgery, Jingmen People's Hospital, Jingchu University of Technology Affiliated Central Hospital, Jingmen, 448000, Hubei province, China. Electronic address: nianbeifch@163.com.

PMID: 38548574
DOI: 10.1016/j.cjtee.2024.03.006

Abstract

Purpose: Although traditional craniotomy (TC) surgery has failed to show benefits for the functional outcome of intracerebral hemorrhage (ICH). However, a minimally invasive hematoma removal plan to avoid white matter fiber damage may be a safer and more feasible surgical approach, which may improve the prognosis of ICH. We conducted a historical cohort study on the use of multimodal image fusion-assisted neuroendoscopic surgery (MINS) for the treatment of ICH, and compared its safety and effectiveness with traditional methods.

Methods: This is a historical cohort study involving 241 patients with cerebral hemorrhage. Divided into MINS group and TC group based on surgical methods. Multimodal images (CT skull, CT angiography, and white matter fiber of MRI diffusion-tensor imaging) were fused into 3 dimensional images for preoperative planning and intraoperative guidance of endoscopic hematoma removal in the MINS group. Clinical features, operative efficiency, perioperative complications, and prognoses between 2 groups were compared. Normally distributed data were analyzed using t-test of 2 independent samples, Non-normally distributed data were compared using the Kruskal-Wallis test. Meanwhile categorical data were analyzed via the Chi-square test or Fisher's exact test. All statistical tests were two-sided, and p < 0.05 was considered statistically significant.

Results: A total of 42 patients with ICH were enrolled, who underwent TC surgery or MINS. Patients who underwent MINS had shorter operative time (p < 0.001), less blood loss (p < 0.001), better hematoma evacuation (p = 0.003), and a shorter stay in the intensive care unit (p = 0.002) than patients who underwent TC. Based on clinical characteristics and analysis of perioperative complications, there is no significant difference between the 2 surgical methods. Modified Rankin scale scores at 180 days were better in the MINS than in the TC group (p = 0.014).

Conclusions: Compared with TC for the treatment of ICH, MINS is safer and more efficient in cleaning ICH, which improved the prognosis of the patients. In the future, a larger sample size clinical trial will be needed to evaluate its efficacy.

Keywords: Endoscopic surgery; Hematoma evacuation; Intracerebral hemorrhage; Multimodal image; Traditional craniotomy.