Comparative analysis of the efficacy between minimally invasive drilling drainage and neuroendoscopic hematoma removal for the treatment of critical

doi:10.3877/cma.j.issn.2095-9141.2024.05.005

Abstract

Abstract:

Objective

To compare the efficacy of minimally invasive drilling drainage and neuroendoscopic hematoma removal for treatment of critical basal ganglia hemorrhage.

Methods

A prospective study was conducted on 60 patients with critical basal ganglia hemorrhage admitted to Neurosurgery Department of Xuzhou Central Hospital from January 2020 to January 2023. The patients were randomly divided into neuroendoscopic group （30 cases） and puncture drainage group （30 cases）.Neuroendoscopic surgery and puncture drainage were performed respectively. The perioperative indicators， as well as the levels of interleukin-6 （IL-6） and neuron specific enolase （NSE） before and 1， 2，and 4 weeks after surgery， were compared between the two groups. The changes in the National Institutes of Health stroke scale （NIHSS） score， GCS score， and Montreal cognitive assessment （MoCA） score of the two groups were observed after surgery.

Results

The hematoma clearance rate of the puncture drainage group was slightly lower than that of the neuroendoscopic group， but the surgical time，hospitalization time， and hospitalization costs were all less than those of the neuroendoscopic group， and the differences were statistically significant （P＜0.05）. As the course of the disease prolonged， the levels of IL-6 and NSE in both groups decreased significantly at 1， 2， and 4 weeks after surgery compared to preoperative levels， with the puncture drainage group showing a more significant decrease， and the differences were statistically significant （P＜0.05）； The GCS scores of the two groups gradually increased at 1， 2， and 4 weeks after surgery compared to preoperative levels， while the NIHSS scores gradually decreased， and the improvement was more significant in the puncture drainage group， the differences were statistically significant （P＜0.05）. The MoCA scores of both groups at 4 weeks after surgery were higher than those before surgery， and the MoCA score was higher in the puncture drainage group than in the neuroendoscopic group， with statistical significance （P＜0.05）.

Conclusion

Compared with neuroendoscopic hematoma removal， minimally invasive drilling drainage can more effectively improve cognitive dysfunction in patients with critical basal ganglia hemorrhage， reduce IL-6 and NSE levels，decrease the degree of postoperative cranial brain injury， shorten hospitalization time and overall hospitalization costs，and improve patient prognosis.

Key words: Critical basal ganglia hemorrhage, Neuroendoscopy, Minimally invasive drilling drainage, Neuron-specific enolase, Interleukin-6

Yongnan Wang, Changtong Tang, Jie Yin, Yitao Tan. Comparative analysis of the efficacy between minimally invasive drilling drainage and neuroendoscopic hematoma removal for the treatment of critical[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2024, 10(05): 286-292.

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Figures/Tables 5

Tab.1 Comparison of general information between two groups

组别	例数	性别（男/女）	年龄（岁， $\overset{ˉ}{x}$ ±s）	术前血肿量（mL， $\overset{ˉ}{x}$ ±s）	出血侧别（左/右）	入院收缩压（mmHg， $\overset{ˉ}{x}$ ±s）	发病至术前时间（h， $\overset{ˉ}{x}$ ±s）
钻孔组	30	17/13	62.50±5.13	29.17±3.62	20/10	166.03±7.58	9.31±0.79
内镜组	30	18/12	62.47±5.99	29.80±4.04	21/19	170.53±11.94	9.69±0.72
t/χ²值		0.069	0.023	-0.640	1.418	-1.743	-1.925
P值		0.793	0.982	0.525	0.234	0.087	0.059

Tab.1 Comparison of general information between two groups

组别	例数	性别（男/女）	年龄（岁， $\overset{ˉ}{x}$ ±s）	术前血肿量（mL， $\overset{ˉ}{x}$ ±s）	出血侧别（左/右）	入院收缩压（mmHg， $\overset{ˉ}{x}$ ±s）	发病至术前时间（h， $\overset{ˉ}{x}$ ±s）
钻孔组	30	17/13	62.50±5.13	29.17±3.62	20/10	166.03±7.58	9.31±0.79
内镜组	30	18/12	62.47±5.99	29.80±4.04	21/19	170.53±11.94	9.69±0.72
t/χ²值		0.069	0.023	-0.640	1.418	-1.743	-1.925
P值		0.793	0.982	0.525	0.234	0.087	0.059

Tab.2 Comparison of perioperative indicators between two groups

组别	例数	手术时间（min， $\overset{ˉ}{x}$ ±s）	血肿清除率（%， $\overset{ˉ}{x}$ ±s）	住院时间（d， $\overset{ˉ}{x}$ ±s）	住院费用[万，M（P₂₅，P₇₅）]
钻孔组	30	42.07±5.91	70.02±4.16	15.03±2.13	4.2（3.28，4.63）
内镜组	30	81.92±11.63	89.86±2.85	16.53±3.25	5.0（4.38，5.40）
t/Z值		-16.735	-21.544	-2.118	-3.632
P值		＜0.001	＜0.001	0.038	＜0.001

Tab.2 Comparison of perioperative indicators between two groups

组别	例数	手术时间（min， $\overset{ˉ}{x}$ ±s）	血肿清除率（%， $\overset{ˉ}{x}$ ±s）	住院时间（d， $\overset{ˉ}{x}$ ±s）	住院费用[万，M（P₂₅，P₇₅）]
钻孔组	30	42.07±5.91	70.02±4.16	15.03±2.13	4.2（3.28，4.63）
内镜组	30	81.92±11.63	89.86±2.85	16.53±3.25	5.0（4.38，5.40）
t/Z值		-16.735	-21.544	-2.118	-3.632
P值		＜0.001	＜0.001	0.038	＜0.001

Tab.3 Comparison of inflammatory factor indicators before and after surgery between two groups （Mean±SD）

组别	IL-6（pg/mL）				NSE（ng/L）
组别	术前	术后1周	术后2周	术后4周	术前	术后1周	术后2周	术后4周
钻孔组	113.57±11.93	86.51±6.42	65.27±3.07	5.02±0.47	22.78±1.11	19.12±1.19	13.26±0.89	10.28±1.41
内镜组	117.19±12.82	94.93±6.94	72.72±3.96	6.17±0.52	22.47±1.34	20.44±0.86	16.23±0.65	14.43±1.61
t值	-1.132	0.630	-8.137	-8.950	0.978	-4.915	-14.715	-10.613
P值	0.262	＜0.001	＜0.001	＜0.001	0.332	＜0.001	＜0.001	＜0.001
时间效应	F=3921.671，P＜0.001				F=6191.999，P＜0.001
组间效应	F=5.080，P=0.023				F=268.679，P＜0.001
交互效应	F=14.633，P＜0.001				F=50.921，P＜0.001

Tab.4 GCS and NIHSS scores before and after surgery in two groups of patients（score，Mean±SD）

组别	GCS评分				NIHSS评分
组别	术前	术后1周	术后2周	术后4周	术前	术后1周	术后2周	术后4周
钻孔组	8.03±1.83	10.03±0.81	11.53±1.72	13.30±1.39	20.17±1.51	13.20±1.21	10.33±1.21	7.00±0.78
内镜组	8.50±1.68	8.90±0.84	9.77±1.38	11.80±1.56	20.73±1.23	16.77±1.13	13.67±1.18	10.03±0.93
t值	-1.030	5.308	4.391	3.924	-1.593	-11.750	-10.770	-13.649
P值	0.307	＜0.001	＜0.001	＜0.001	0.117	＜0.001	＜0.001	＜0.001
时间效应	F=238.019，P＜0.001				F=5106.605，P＜0.001
组间效应	F=17.891，P＜0.001				F=96.486，P＜0.001
交互效应	F=9.899，P=0.002				F=90.736，P＜0.001

Tab.5 Comparison of MoCA scores between two groups before and after surgery（score，Mean±SD）

组别	例数	术前	术后4周	t值	P值
钻孔组	30	10.57±1.81	16.43±1.77	-12.663	＜0.001
内镜组	30	10.40±1.61	15.03±2.19	-9.339	＜0.001
t值		0.376	2.721
P值		0.708	0.009

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