Skip to main content
SpringerLink
Log in

Treatment outcomes between endoscopic surgery and conventional craniotomy for spontaneous supratentorial intracerebral hemorrhage: a randomized controlled trial

  • Research
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Minimally invasive surgery (MIS) has been repeatedly evaluated in patients with ICH as a promising procedure for improved survival and functional outcome. Among MIS techniques, endoscopic surgery (ES) has shown superior efficacy for ICH removal due to rapid clot evacuation and immediate bleeding control. However, the results of ES are still uncertain due to insufficient data. In this study, participants with spontaneous supratentorial ICH who were indicated for surgery were randomly assigned (1:1) to undergo ES or conventional craniotomy (CC) between March 2019 and June 2022. The primary outcome was a difference in favorable modified Rankin Scale (mRS) outcome (0 to 3) at 180-day follow-up evaluated by blind assessors. There were 188 participants, 95 in the ES group and 93 in the CC group, who completed the trial. At 180-day follow-up, 46 (48.4%) participants in the ES group achieved favorable outcomes, compared to 33 (35.5%) in the CC group (risk difference [RD] 12.9, 95% CI − 1.1–27.0, p = 0.07). After covariate adjustment, the difference was slightly higher and significant (adjusted RD 17.3, 95% CI [4.6–30.0], p = 0.01). Moreover, the ES group had less operative duration and less intraoperative blood loss than the CC group. Clot evacuation rate and complications were similar between the two groups. Subgroup analyses showed a potential benefit of ES in age < 60 years, time to surgery ≥ 6 h, and deep ICH. This study showed that ES was safe and effective in ICH removal and provided a better functional outcome compared to CC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research, supporting data is not available.

References  

  1. Hsu C-H, Chou S-C, Kuo L-T, Huang S-J, Yang S-H, Lai D-M, Huang AP-H (2022) Minimally invasive neurosurgery for spontaneous intracerebral hemorrhage—10 years of working progress at National Taiwan University Hospital. Front Neurol 13:817386

    Article  PubMed  PubMed Central  Google Scholar 

  2. Al-Mufti F, Thabet AM, Singh T, El-Ghanem M, Amuluru K, Gandhi CD (2018) Clinical and radiographic predictors of intracerebral hemorrhage outcome. Interv Neurol 7:118–136. https://doi.org/10.1159/000484571

    Article  PubMed  PubMed Central  Google Scholar 

  3. Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, Karimi A, Shaw MDM, Barer DH, STICH investigators (2005) Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet 365:387–397. https://doi.org/10.1016/S0140-6736(05)17826-X

    Article  PubMed  Google Scholar 

  4. Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM, Investigators STICHII (2013) Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet 382:397–408. https://doi.org/10.1016/S0140-6736(13)60986-1

    Article  PubMed  PubMed Central  Google Scholar 

  5. Vespa P, Hanley D, Betz J, Hoffer A, Engh J, Carter R, Nakaji P, Ogilvy C, Jallo J, Selman W, Bistran-Hall A, Lane K, McBee N, Saver J, Thompson RE, Martin N, Investigators ICES (2016) ICES (intraoperative stereotactic computed tomography-guided endoscopic surgery) for brain hemorrhage: a multicenter randomized controlled trial. Stroke 47:2749–2755. https://doi.org/10.1161/STROKEAHA.116.013837

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ye Z, Ai X, Hu X, Fang F, You C (2017) Comparison of neuroendoscopic surgery and craniotomy for supratentorial hypertensive intracerebral hemorrhage: A meta-analysis. Medicine (Baltimore) 96(35):e7876. https://doi.org/10.1097/MD.0000000000007876

  7. Nagasaka T, Tsugeno M, Ikeda H, Okamoto T, Inao S, Wakabayashi T (2011) Early recovery and better evacuation rate in neuroendoscopic surgery for spontaneous intracerebral hemorrhage using a multifunctional cannula: preliminary study in comparison with craniotomy. J Stroke Cerebrovasc Dis 20:208–213. https://doi.org/10.1016/j.jstrokecerebrovasdis.2009.11.021

    Article  PubMed  Google Scholar 

  8. Fiorella D, Arthur A, Bain M, Mocco J (2016) Minimally invasive surgery for intracerebral and intraventricular hemorrhage: rationale, review of existing data and emerging technologies. Stroke 47:1399–1406. https://doi.org/10.1161/STROKEAHA.115.011415

    Article  PubMed  Google Scholar 

  9. Greenberg SM, Ziai WC, Cordonnier C, Dowlatshahi D, Francis B, Goldstein JN, Hemphill JC, Johnson R, Keigher KM, Mack WJ, Mocco J, Newton EJ, Ruff IM, Sansing LH, Schulman S, Selim MH, Sheth KN, Sprigg N, Sunnerhagen KS, null null, (2022) 2022 Guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke 53:e282–e361. https://doi.org/10.1161/STR.0000000000000407

    Article  PubMed  CAS  Google Scholar 

  10. Kobata H, Ikeda N (2021) Recent updates in neurosurgical interventions for spontaneous intracerebral hemorrhage: minimally invasive surgery to improve surgical performance. Front Neurol 12:703189

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sun S, Li Y, Zhang H, Gao H, Zhou X, Xu Y, Yan K, Wang X (2020) Neuroendoscopic surgery versus craniotomy for supratentorial hypertensive intracerebral hemorrhage: a systematic review and meta-analysis. World Neurosurg 134:477–488. https://doi.org/10.1016/j.wneu.2019.10.115

  12. Yang C-D, Chen Y-W, Wu H-C (2014) Meta-analysis of randomized studies of surgery for supratentorial intracerebral hemorrhage. Formosan J Surg 47:90–98. https://doi.org/10.1016/j.fjs.2013.12.005

    Article  Google Scholar 

  13. Zhou H, Zhang Y, Liu L, Han X, Tao Y, Tang Y, Hua W, Xue J, Dong Q (2011) A prospective controlled study: minimally invasive stereotactic puncture therapy versus conventional craniotomy in the treatment of acute intracerebral hemorrhage. BMC Neurol 11:76. https://doi.org/10.1186/1471-2377-11-76

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hanley DF, Thompson RE, Rosenblum M, Yenokyan G, Lane K, McBee N, Mayo SW, Bistran-Hall AJ, Gandhi D, Mould WA, Ullman N, Ali H, Carhuapoma JR, Kase CS, Lees KR, Dawson J, Wilson A, Betz JF, Sugar EA, Hao Y, Avadhani R, Caron J-L, Harrigan MR, Carlson AP, Bulters D, LeDoux D, Huang J, Cobb C, Gupta G, Kitagawa R, Chicoine MR, Patel H, Dodd R, Camarata PJ, Wolfe S, Stadnik A, Money PL, Mitchell P, Sarabia R, Harnof S, Barzo P, Unterberg A, Teitelbaum JS, Wang W, Anderson CS, Mendelow AD, Gregson B, Janis S, Vespa P, Ziai W, Zuccarello M, Awad IA, Abdul-Rahim A, Abou-Hamden A, Abraham M, Ahmed A, Alba CA, Aldrich EF, Altschul D, Amin-Hanjani S, Anderson D, Ansari S, Antezana D, Ardelt A, Arikan F, Baguena M, Baker A, Barrer SJ, Becker KJ, Bergman T, Boström A, Braun J, Brindley P, Broaddus WC, Brown R, Buki A, Cao B, Cao Y, Carrion-Penagos J, Chalela J, Chang T, Chorro IM, Chowdhry S, Corral L, Csiba L, Davies J, Díaz AT, Derdeyn CP, Diringer M, Dlugash R, Ecker R, Economas T, Enriquez P, Ezer E, Fan Y, Feng H, Franz D, Freeman WD, Fusco M, Galicich W, Gelea ML, Goldstein J, Gonzalez AC, Grabarits C, Greenberg S, Gress D, Gu E, Hall C, Hernandez FM, Hoesch R, Hoh BL, Houser J, Hu R, Huang Y, Hussain MA, Insinga S, Jadhav A, Jaffe J, Jahromi BS, Jallo J, James M, James RF, Jankowitz B, Jeon E, Jichici D, Jonczak K, Jonker B, Karlen N, Keric N, Kerz T, Knopman J, Koenig C, Krishnamurthy S, Kumar A, Kureshi I, Laidlaw J, Lakhanpal A, Latorre JG, Leifer D, Leiphart J, Lenington S, Li Y, Lopez G, Lovick D, Lumenta C, Luo J, Maas MB, MacDonald J, MacKenzie L, Madan V, Majkowski R, Major O, Malhorta R, Malkoff M, Mangat H, Maswadeh A, Matouk C, McArthur K, McCaul S, Medow J, Mezey G, Mighty J, Miller D, Mohan KK, Muir K, Muñoz L, Nakaji P, Nee A, Nekoovaght-Tak S, Nyquist P, O’Kane R, Okasha M, O’Kelly C, Ostapkovich N, Pandey A, Parry-Jones A, Perla KR, Pollack A, Polster S, Pouratian N, Quinn T, Rajajee V, Reddy K, Rehman M, Reimer R, Rincon F, Rybinnik I, Sanchez B, Sansing L, Schneck M, Schuerer L, Schul D, Schweitzer J, Seder DB, Seyfried D, Sheth K, Spiotta A, Stechison M, Szabo K, Tamayo G, Tanczos K, Taussky P, Terry J, Testai F, Thomas K, Thompson CB, Thompson G, Torner JC, Tran H, Tucker K, Ungar L, Varelas P, Vargas NM, Vatter H, Venkatasubramanian C, Vermillion K, Vollmer D, Wang Y, Wang Y, Wen J, Whitworth LT, Willis B, Wrencher M, Wright SE, Xu Y, Yanase L, Yi X, Yu Z, Zomorodi A (2019) Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial. The Lancet 393:1021–1032. https://doi.org/10.1016/S0140-6736(19)30195-3

    Article  Google Scholar 

  15. Dong J, Jiang Z, Chen J, Huang N, Chen J, Liu G (2019) Evacuation assisted by endoscopy has better efficacy for supratentorial intracerebral hematoma than CT-guided minimally invasive aspiration: a retrospective observational cohort study. Br J Neurosurg 33:348–351. https://doi.org/10.1080/02688697.2018.1559273

    Article  PubMed  Google Scholar 

  16. Katsuki M, Kakizawa Y, Nishikawa A, Yamamoto Y, Uchiyama T (2020) Endoscopic hematoma removal of supratentorial intracerebral hemorrhage under local anesthesia reduces operative time compared to craniotomy. Sci Rep 10:10389. https://doi.org/10.1038/s41598-020-67456-x

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Labib MA, Shah M, Kassam AB, Young R, Zucker L, Maioriello A, Britz G, Agbi C, Day JD, Gallia G, Kerr R, Pradilla G, Rovin R, Kulwin C, Bailes J (2017) The safety and feasibility of image-guided brainpath-mediated transsulcul hematoma evacuation: a multicenter study. Neurosurgery 80:515–524. https://doi.org/10.1227/NEU.0000000000001316

    Article  PubMed  Google Scholar 

  18. Cho D-Y, Chen C-C, Chang C-S, Lee W-Y, Tso M (2006) Endoscopic surgery for spontaneous basal ganglia hemorrhage: comparing endoscopic surgery, stereotactic aspiration, and craniotomy in noncomatose patients. Surg Neurol 65:547–555. https://doi.org/10.1016/j.surneu.2005.09.032. (discussion 555-556)

    Article  PubMed  Google Scholar 

  19. Mei L, Fengqun M, Qian H, Dongpo S, Zhenzhong G, Tong C (2020) Exploration of efficacy and safety of interventions for intraventricular hemorrhage: a network meta-analysis. World Neurosurg 136:382-389.e6. https://doi.org/10.1016/j.wneu.2019.10.177

    Article  PubMed  Google Scholar 

  20. Yao Z, Hu X, You C, He M (2018) Effect and feasibility of endoscopic surgery in spontaneous intracerebral hemorrhage: a systematic review and meta-analysis. World Neurosurg 113:348-356.e2. https://doi.org/10.1016/j.wneu.2018.02.022

  21. Kellner CP, Chartrain AG, Nistal DA, Scaggiante J, Hom D, Ghatan S, Bederson JB, Mocco J (2018) The Stereotactic Intracerebral Hemorrhage Underwater Blood Aspiration (SCUBA) technique for minimally invasive endoscopic intracerebral hemorrhage evacuation. J Neurointerv Surg 10:771–776. https://doi.org/10.1136/neurintsurg-2017-013719

    Article  PubMed  PubMed Central  Google Scholar 

  22. O’Brien PC, Fleming TR (1979) A multiple testing procedure for clinical trials. Biometrics 35:549–556. https://doi.org/10.2307/2530245

    Article  PubMed  Google Scholar 

  23. Holmberg MJ, Andersen LW (2022) Adjustment for baseline characteristics in randomized clinical trials. JAMA 328:2155–2156. https://doi.org/10.1001/jama.2022.21506

    Article  PubMed  Google Scholar 

  24. Rost NS, Smith EE, Chang Y, Snider RW, Chanderraj R, Schwab K, FitzMaurice E, Wendell L, Goldstein JN, Greenberg SM, Rosand J (2008) Prediction of functional outcome in patients with primary intracerebral hemorrhage. Stroke 39:2304–2309. https://doi.org/10.1161/STROKEAHA.107.512202

    Article  PubMed  Google Scholar 

  25. Morgenstern LB, Demchuk AM, Kim DH, Frankowski RF, Grotta JC (2001) Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage. Neurology 56:1294–1299. https://doi.org/10.1212/wnl.56.10.1294

  26. Hemphill JC, Bonovich DC, Besmertis L, Manley GT, Johnston SC (2001) The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke 32:891–897. https://doi.org/10.1161/01.str.32.4.891

    Article  PubMed  Google Scholar 

  27. Gregson BA, Mitchell P, Mendelow AD (2019) Surgical decision making in brain hemorrhage. Stroke 50:1108–1115. https://doi.org/10.1161/STROKEAHA.118.022694

    Article  PubMed  PubMed Central  Google Scholar 

  28. He X, Chen M, Du C, Zhao K, Yang M, Ma Q (2020) A novel model for predicting the outcome of intracerebral hemorrhage: based on 1186 Patients. J Stroke Cerebrovasc Dis 29:104. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104867

    Article  Google Scholar 

  29. Vitt JR, Sun C-H, Le Roux PD, Hemphill JCI (2020) Minimally invasive surgery for intracerebral hemorrhage. Curr Opin Crit Care 26:129. https://doi.org/10.1097/MCC.0000000000000695

    Article  PubMed  Google Scholar 

  30. Cai Q, Zhang H, Zhao D, Yang Z, Hu K, Wang L, Zhang W, Chen Z, Chen Q (2017) Analysis of three surgical treatments for spontaneous supratentorial intracerebral hemorrhage. Medicine (Baltimore) 96:e8435. https://doi.org/10.1097/MD.0000000000008435

    Article  PubMed  Google Scholar 

  31. Przybylowski CJ, Ding D, Starke RM, Webster Crowley R, Liu KC (2015) Endoport-assisted surgery for the management of spontaneous intracerebral hemorrhage. J Clin Neurosci 22:1727–1732. https://doi.org/10.1016/j.jocn.2015.05.015

    Article  PubMed  Google Scholar 

  32. Xu X, Chen X, Li F, Zheng X, Wang Q, Sun G, Zhang J, Xu B (2017) Effectiveness of endoscopic surgery for supratentorial hypertensive intracerebral hemorrhage: a comparison with craniotomy. J Neurosurg 128:553–559. https://doi.org/10.3171/2016.10.JNS161589

    Article  PubMed  Google Scholar 

  33. Scaggiante J, Zhang X, Mocco J, Kellner CP (2018) Minimally invasive surgery for intracerebral hemorrhage. Stroke 49:2612–2620. https://doi.org/10.1161/STROKEAHA.118.020688

    Article  PubMed  Google Scholar 

  34. Auer LM, Deinsberger W, Niederkorn K, Gell G, Kleinert R, Schneider G, Holzer P, Bone G, Mokry M, Körner E (1989) Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. J Neurosurg 70:530–535. https://doi.org/10.3171/jns.1989.70.4.0530

    Article  PubMed  CAS  Google Scholar 

  35. Luzzi S, Elia A, Del Maestro M, Morotti A, Elbabaa SK, Cavallini A, Galzio R (2019) Indication, timing, and surgical treatment of spontaneous intracerebral hemorrhage: systematic review and proposal of a management algorithm. World Neurosurg 124:e769–e778. https://doi.org/10.1016/j.wneu.2019.01.016

    Article  PubMed  Google Scholar 

  36. Rabinstein AA, Wijdicks EFM (2006) Surgery for intracerebral hematoma: the search for the elusive right candidate. Rev Neurol Dis 3:163–172

    PubMed  Google Scholar 

  37. Zhou X, Chen J, Li Q, Ren G, Yao G, Liu M, Dong Q, Guo J, Li L, Guo J, Xie P (2012) Minimally invasive surgery for spontaneous supratentorial intracerebral hemorrhage: a meta-analysis of randomized controlled trials. Stroke 43:2923–2930. https://doi.org/10.1161/STROKEAHA.112.667535

    Article  PubMed  Google Scholar 

  38. Ariesen MJ, Claus SP, Rinkel GJE, Algra A (2003) Risk factors for intracerebral hemorrhage in the general population. Stroke 34:2060–2065. https://doi.org/10.1161/01.STR.0000080678.09344.8D

    Article  PubMed  CAS  Google Scholar 

  39. Gregson BA, Broderick JP, Auer LM, Batjer H, Chen X-C, Juvela S, Morgenstern LB, Pantazis GC, Teernstra OPM, Wang W-Z, Zuccarello M, Mendelow AD (2012) Individual patient data subgroup meta-analysis of surgery for spontaneous supratentorial intracerebral hemorrhage. Stroke 43:1496–1504. https://doi.org/10.1161/STROKEAHA.111.640284

    Article  PubMed  PubMed Central  Google Scholar 

  40. Koivunen R-J (2015) Intracerebral hemorrhage in young adults

  41. Guo G, Guo W, Feng Y, Deng H, Zhang P, Tang Y, Wu G, Li Q, Pan C, Tang Z (2020) Therapeutic time window of minimally invasive surgery for intracerebral hemorrhage. Brain Hemorrhages 1:158–160. https://doi.org/10.1016/j.hest.2020.07.002

    Article  Google Scholar 

  42. Sondag L, Schreuder FHBM, Boogaarts HD, Rovers MM, Vandertop WP, Dammers R, Klijn CJM, the Dutch ICH Surgery Trial Study Group part of the C consortium† (2020) Neurosurgical intervention for supratentorial intracerebral hemorrhage. Ann Neurol 88:239–250. https://doi.org/10.1002/ana.25732

    Article  PubMed  PubMed Central  Google Scholar 

  43. Pantazis G, Tsitsopoulos P, Mihas C, Katsiva V, Stavrianos V, Zymaris S (2006) Early surgical treatment vs conservative management for spontaneous supratentorial intracerebral hematomas: a prospective randomized study. Surg Neurol 66:492–501. https://doi.org/10.1016/j.surneu.2006.05.054. (discussion 501-502)

    Article  PubMed  Google Scholar 

  44. Li Z, Li Y, Xu F, Zhang X, Tian Q, Li L (2017) Minimal invasive puncture and drainage versus endoscopic surgery for spontaneous intracerebral hemorrhage in basal ganglia. NDT 13:213–219. https://doi.org/10.2147/NDT.S120368

    Article  Google Scholar 

  45. Li Y, Yang R, Li Z, Yang Y, Tian B, Zhang X, Wang B, Lu D, Guo S, Man M, Yang Y, Luo T, Gao G, Li L (2017) Surgical evacuation of spontaneous supratentorial lobar intracerebral hemorrhage: comparison of safety and efficacy of stereotactic aspiration, endoscopic surgery, and craniotomy. World Neurosurg 105:332–340. https://doi.org/10.1016/j.wneu.2017.05.134

    Article  PubMed  Google Scholar 

  46. Penumbra Inc. (2023) MIND: A prospective, multicenter study of artemis a minimally invasive neuro evacuation device, in the removal of intracerebral hemorrhage. clinicaltrials.gov

  47. INVEST feasibility - minimally invasive endoscopic surgery with Apollo in patients with brain hemorrhage - tabular view - ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/record/NCT02654015. Accessed 27 Mar 2023

  48. Nico Corporation (2022) ENRICH: A multi-center, randomized, clinical trial comparing standard medical management to early surgical hematoma evacuation using minimally invasive parafascicular surgery (MIPS) in the treatment of intracerebral hemorrhage (ICH). clinicaltrials.gov

Download references

Acknowledgements

The authors wish to thank Dr. Tadashi Watanabe, Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan, for the supervision of the endoscopic technique for clot removal.

Funding

This study was supported by a grant from the Faculty of Medicine, Thammasat University, Thailand. Grant number: TP.2–05/2565.

Author information

Authors and Affiliations

  1. Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand

    Raywat Noiphithak, Vich Yindeedej, Warot Ratanavinitkul, Gahn Duangprasert, Pree Nimmannitya & Pornchai Yodwisithsak

Authors
  1. Raywat Noiphithak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vich Yindeedej
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Warot Ratanavinitkul
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gahn Duangprasert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pree Nimmannitya
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pornchai Yodwisithsak
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Raywat Noiphithak, Vich Yindeedej, Warot Ratanavinitkul, and Gahn Duangprasert. The first draft of the manuscript was written by Raywat Noiphithak and Vich Yindeedej. This study was conducted under the supervision of Pree Nimmannitya, M.D., and Pornchai Yodwisithsak, M.D. Raywat Noiphithak read and approved the final manuscript on behalf of all authors.

Corresponding author

Correspondence to Raywat Noiphithak.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Human Research Ethic Committee of Thammasat University No. 1 on February 5, 2019 (MTU-EC-SU-2–241/61). The authors obtained consent from all participants for their participation in this research study.

Consent for publication

This work has not been presented or published anywhere in any language.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Noiphithak, R., Yindeedej, V., Ratanavinitkul, W. et al. Treatment outcomes between endoscopic surgery and conventional craniotomy for spontaneous supratentorial intracerebral hemorrhage: a randomized controlled trial. Neurosurg Rev 46, 136 (2023). https://doi.org/10.1007/s10143-023-02035-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10143-023-02035-y

Keywords

Search

Navigation