Comparative Analysis of Neurological Function and Prognosis After Stereotactic Aspiration and Neuroendoscopic Surgery for Hypertensive Intracerebral Hemorrhage.

Aim: In recent years, minimally invasive surgery has become a preferred treatment for hypertensive intracerebral hemorrhage (HICH). This study aims to comprehensively compare the neurological function and prognosis of neuroendoscopic surgery (NS) and stereotactic aspiration (SA) in patients with HICH.

Methods: A total of 247 patients with HICH admitted to Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University from April 2020 to December 2023 were included. Patients were divided into the NS group (65 cases) and the SA group (182 cases). The perioperative indicators, serum neurological function, complications, and functional prognosis were compared between the two groups.

Results: The SA group demonstrated higher hematoma clearance rate with lower hematoma residual volumes and intraoperative blood loss than the NS group (p < 0.05). Compared with these before surgery, serum brain-derived neurotrophic factor (BDNF) levels increased, neuron-specific enolase (NSE) and glial fibrillary acidic protein (GFAP) levels decreased in both groups at 1 and 3 months post-surgery (p < 0.05). The SA group showed higher BDNF and lower NSE and GFAP levels at 1 and 3 months post-surgery than the NS group (p < 0.05). Compared with these before surgery, both groups showed lower National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) score and higher Glasgow Outcome Scale (GOS) scores at 1 and 3 months post-surgery, with the SA group performing better than the NS group post-surgery (p < 0.05). There was no difference in the complications rates between the two groups (p > 0.05). At 3- and 6-months post-surgery, the SA group showed higher Mini-Mental State Examination (MMSE) scores than the NS group (p < 0.05). At 3 months post-surgery, the SA group showed higher activities of daily living (ADL) scores than the NS group (p < 0.05), but no difference at 6 months post-surgery (p > 0.05).

Conclusions: In the treatment of HICH, compared to NS, SA offers advantages in hematoma clearance and intraoperative bleeding reduction. Additionally, SA more effectively improves neurological function, quality of life, and cognitive ability in HICH patients.