Objective: The treatment effect of minimally invasive surgery (MIS) for spontaneous intracerebral hemorrhage (sICH) remains controversial. Intracerebral hemorrhage patients with intraventricular hemorrhage (IVH) seemingly have a worse prognosis. So we aim to verify the efficacy of MIS for small and medium cerebral hemorrhage (15-30ml) using the propensity score matching (PSM)method which could reduce the heterogeneity, and further analyze the different treatment effects of MIS for sICH with or without IVH.
Methods: We collected the data of patients with sICH from January 2016 to March 2021 retrospectively. The propensity score matching method was used to compare the clinical outcomes of surgery and conservative treatments. The primary outcome was neurological prognosis. The second outcomes were the rate of complications, length of stay, and hospitalization expenses. Furthermore, we use the binary logistic regression analysis to explore the influence of MIS on patients' prognosis.
Results: For all sICH patients, the Modified Rankin Scale (MRS) and Glasgow Outcome Scale (GOS) of the surgery group were worse than those of the conservative group. The length of stay (P = .001), hospitalization expenses (P < .01), pneumonia incidence (P < 0.01), and history of tracheotomy (P = .002) of the surgery group were higher than those of the conservative group. For sICH patients without IVH, the GOS and MRS of surgery patients were statistically better than those of conservative patients at 3 months. The length of stay (P = .046), hospitalization expenses (P < .001), and pneumonia incidence (P < .001) of the surgery group were also higher than the conservative group. Binary logistic analysis showed that MIS is the protective factor for patients' neurological function, especially for intracerebral hemorrhage patients without IVH (OR = 66.636).
Conclusions: For small and medium cerebral hemorrhage, stereotactic puncture drainage minimally invasive surgery could result in better functional outcomes, especially for the sICH patients without IVH.Nevertheless, surgery cannot reduce the occurrence of complications, hospitalization length, and expenses.