Comparison of endoscopic evacuation, craniotomy, and puncture aspiration for the treatment of spontaneous basal ganglia intracerebral hematoma

Objective: To compare the prognosis of patients with spontaneous basal ganglia intracerebral hematoma treated by endoscopic evacuation, craniotomy, or puncture aspiration.Methods: This retrospective observational study included information from patients with basal ganglia hematoma who received craniotomy, endoscopic evacuation, or puncture aspiration in the Department of Neurosurgery of the First Affiliated Hospital of USTC between January 2016 and May 2021. Patients were grouped according to their treatment method for comparison.Results: From a total of 184 patients, 62 cases (51 males, aged 54.44 +/- 9.92 years) received craniotomy, 64 cases (45 males, aged 53.97 +/- 11.87 years) received endoscopic evacuation, and 58 cases (43 males, aged 54.25 +/- 10.35 years) received puncture aspiration. No significant difference was found in baseline characteristics among three surgical procedures. Patients in the endoscopy group had the shortest hospital stay (15.16 +/- 4.89 days vs. 17.88 +/- 5.97 and 20.77 +/- 6.96 days), lowest infectious meningitis [1(1.6 %) vs. 2(3.4%) and 8(12.9%)] and pulmonary infection [3(4.7%) vs. 5(8.6%) and 13(21.0%)] rates, and highest hematoma removal rate (90.39 +/- 5.22% vs. 35.87 +/- 6.23 and 84.76 +/- 4.91%) and Glasgow outcome scale 6 months after surgery (4.41 +/- 0.53 vs. 3.74 +/- 1.09 and 3.81 +/- 1.03). The occurrence of gastrointestinal bleeding, epilepsy, and mortality were similar (all p > 0.05) among the groups.Conclusion: Patients with spontaneous basal ganglia intracerebral hematoma who received endoscopic evacuation might have better prognosis than those treated with craniotomy or puncture aspiration. In future, endoscopic surgery could become the most common method for treating spontaneous basal ganglia hemorrhages.