Assessing the Effect of Neuroendoscopic Surgery on Cerebral Hemodynamics and Functional Recovery in Patients With Brain Hemorrhage.

Abstract

Aim: This study aims to investigate the impact of neuroendoscopic surgery on cerebral hemodynamics and functional recovery in patients with different brain hemorrhage severities.

Methods: This study included 161 patients with brain hemorrhage who were admitted to the Affiliated Hospital of Putian University, China, between January 2021 and January 2022. Patients were divided into a neuroendoscopy group and a minimally invasive drilling group based on the surgical techniques. Furthermore, patients in the neuroendoscopy group were further stratified into mild, moderate, and severe subgroups based on their Glasgow Coma Scale (GCS) scores. Surgical outcomes, including hemorrhage volume, hematoma clearance rate, surgical duration, and postoperative hemorrhage volume, were compared between the two groups. Additionally, cerebral hemodynamic parameters, such as critical pressure (CP), mean blood flow quantity (Qmean), peripheral resistance (Rv), mean blood flow velocity (Vm), and pulsatility index (PI), were recorded before surgery and 7 days postoperatively. Functional recovery was assessed using the National Institutes of Health Stroke Scale (NIHSS), the Fugl-Meyer Assessment (FMA), and the Coma Recovery Scale-Revised (CRS-R).

Results: Compared to the minimally invasive drilling group, the neuroendoscopy group exhibited greater intraoperative hemorrhage volume (p < 0.001), higher hematoma clearance rate at 24 hours post-surgery (p < 0.001), longer surgical duration (p < 0.001), and lower postoperative hemorrhage volume (p < 0.001). However, 7 days postsurgery, the neuroendoscopy group demonstrated significantly higher Qmean (p < 0.001) and Vm (p < 0.001) and lower CP (p < 0.001), Rv (p < 0.001), and PI (p < 0.001) compared to the minimally invasive drilling group. Within the neuroendoscopy group, patients in the severe subgroup had higher PI values 7 days after surgery than those in the mild and moderate subgroups. Assessment of functional recovery outcomes indicated that the neuroendoscopy group had greater improvements, with significantly lower NIHSS scores (p < 0.01) and higher FMA (p < 0.01) and CRS-R scores (p < 0.01) compared to the minimally invasive drilling group. Furthermore, mild and moderate subgroups showed greater reductions in NIHSS scores (p < 0.05) and increases in FMA (p < 0.05) and CRS-R scores (p < 0.05) than the severe subgroup.

Conclusions: Neuroendoscopic treatment may effectively improve cerebral hemodynamics and promote functional recovery in patients with brain hemorrhage, with the impacts being more pronounced in patients with mild or moderate hemorrhage compared to those with severe conditions.