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The impact of time to evacuation on outcomes in endoscopic surgery for supratentorial spontaneous intracerebral hemorrhage: a single-center retrospective study

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Abstract

Supratentorial spontaneous intracerebral hemorrhage (SICH) can be treated with endoscopic surgery, but the optimal timing remains uncertain. We retrospectively analyzed data from 46 patients who underwent endoscopic surgery for supratentorial SICH. We examined the relationship between time to evacuation and functional outcome at 3 months, adjusting for prognostic factors. Surgical outcomes and complications were compared between patients with early (≤ 12 h) or late (> 12 h) evacuation. Median time to evacuation was 12 h, and the rate of unfavorable outcome (modified Rankin Scale > 3 at 3 months) was 32.6%. Longer time to evacuation was independently associated with unfavorable outcome (odds ratio per hour delay: 1.26). Late evacuation carried a 7.25-fold higher risk of unfavorable outcome compared to early evacuation. This association held across subgroups based on hematoma volume, location, and intraventricular extension (P for interaction > 0.05). Patients with late evacuation had fewer spot signs (24% vs. 4.8%, P = 0.035) and markers of hemorrhagic expansion (36% vs. 9.5%, P = 0.018), longer neurosurgical intensive care unit (NSICU) stay (3.2 vs. 1.9 days, P = 0.011) and hospital stay (15.7 vs. 11.9 days, P = 0.014), and higher 30-day mortality (28.6 vs. 4%, P = 0.036) and complication rates (57.1% vs. 28.0%, P = 0.023). This study suggests a potential association between early endoscopic evacuation of supratentorial SICH and improved functional outcomes, lower 30-day mortality and reduced complications. The need for timely intervention in managing supratentorial SICH is highlighted, yet further validation through multi-center prospective studies is essential to substantiate these findings and provide a higher level of evidence.

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Data availability

The dataset and material are available from the corresponding authors on reasonable request.

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Funding

This work was supported by the “Science and Technology Innovation Action Plan” for Domestic S&T Cooperation [grant number 23015830700] from the Shanghai Municipal Science and Technology Commission and the Clinical Research Project [grant number 2023-LC-05] from the People’s Hospital of Jinping Miao, Yao, and Dai Autonomous County.

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Author notes

  1. Shuang Liu and Shengyang Su contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China

    Shuang Liu, Fan Hu & Xiaobiao Zhang

  2. Department of Surgery, People’s Hospital of Jinping Miao, Yao and Dai Autonomous Country, Honghe Prefecture, Yunnan Province, China

    Shengyang Su, Jinyong Long, Shikui Cao, Jirao Ren, Fuhua Li, Shoulong Wang, Huatao Niu & Zihui Gao

  3. Department of Neurological Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China

    Shoulong Wang & Huatao Niu

  4. Department of Neurology, People’s Hospital of Jinping Miao, Yao and Dai Autonomous Country, Honghe Prefecture, Yunnan Province, China

    Huaxing Gao

  5. Department of Critical Care Medicine, People’s Hospital of Jinping Miao, Yao and Dai Autonomous Country, Honghe Prefecture, Yunnan Province, China

    Deqiang Wang

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  1. Shuang Liu
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  13. Xiaobiao Zhang
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Contributions

SL, SS, JL, SC, XZ contributed to the conception and design of the study. FL, SL, SW, HN, SS, JR contributed to the acquisition and analysis of data. ZG, HG, QW, SL, GX, FH contributed to the clinical assessment of the data. The first draft of the manuscript was written by SL and XZ. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Xiaobiao Zhang.

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Ethics approval

This study involves human participants and was approved by the Ethics Committee of People’s Hospital of Jinping Miao, Yao and Dai Autonomous County [grant number 2023-LL-0012].

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The authors have no relevant financial or non-financial interests to disclose.

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Liu, S., Su, S., Long, J. et al. The impact of time to evacuation on outcomes in endoscopic surgery for supratentorial spontaneous intracerebral hemorrhage: a single-center retrospective study. Neurosurg Rev 47, 2 (2024). https://doi.org/10.1007/s10143-023-02237-4

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