Introduction: There is a significantly increased number of intracerebral hemorrhage (ICH) patients that coagulopathic. However, there is no literature in comparing the different ways of surgical treatments in these patients.
Methods: We retrospectively reviewed the ICH database at our hospital and identified patients who received surgical treatment. Patients with end-stage renal disease, liver cirrhosis, elevated PT/PTT, and patients that are on anti-platelet or anticoagulants were included. We compared the rebleeding rate, morbidity, mortality, and functional outcome between the endoscopic group and the craniotomy group.
Results: There are totally 58 coagulopathic patients that are surgically treated; 30 received traditional craniotomy and 28 received endoscopic assisted evacuation. The mortality rate was 20.0% (6/30) and the rebleeding rate was 13.3% (4/30) in the craniotomy group. The mortality rate was 10.7% (3/28) and the rebleeding rate was 7.1% (2/28) in the endoscopic assisted group.
Conclusions: Endoscopic assisted surgery for ICH might result in less rebleeding and decreased mortality compared to open craniotomy.
Patient Care: Our experience indicated that minimally invasive surgery might have a role in coagulopathic ICH patients in decreasing rebleeding and surgical mortality.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of management of ICH patients with coagulopathy 2) Discuss, in the different surgical treatment modalitys and their pros and cons for these patients 3) Identify an effective treatment that may reduce surgical mortality and rebleeding rate.
References: 1: Luh HT, Huang AP, Yang SH, Chen CM, Cho DY, Chen CC, Kuo LT, Li CH, Wang KC, Tseng WL, Hsing MT, Yang BS, Lai DM, Tsai JC. Local hemostatic matrix for endoscope-assisted removal of intracerebral hemorrhage is safe and effective. J Formos Med Assoc. 2018 Jan;117(1):63-70. doi: 10.1016/j.jfma.2017.02.016. Epub 2017 Mar 23. PubMed PMID: 28343893.
2: Kuo LT, Chen CM, Li CH, Tsai JC, Chiu HC, Liu LC, Tu YK, Huang AP. Early
endoscope-assisted hematoma evacuation in patients with supratentorial intracerebral hemorrhage: case selection, surgical technique, and long-term results. Neurosurg Focus. 2011 Apr;30(4):E9. doi: 10.3171/2011.2.FOCUS10313.
PubMed PMID: 21456936.