Minimally-invasive Surgery Versus Craniotomy in Patients With Supratentorial Hypertensive Intracerebral Hemorrhage

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    Chinese PLA General Hospital
Updated on 25 January 2021


The effectiveness of craniotomy in the treatment of intracerebral hemorrhage remains controversial. Two main types of minimally invasive surgery, endoscopic evacuation and stereotactic aspiration, have been attempted for hematoma removal and show some advantages. However, prospective and controlled studies are still lacking. This is a multi-center randomized controlled trial designed to determine whether minimally invasive surgeries will improve the outcome in patients with hypertensive intracerebral hemorrhage compared with craniotomy. Patients will be randomly assigned to endoscopy group, stereotactic aspiration group and craniotomy group in a 1:1:1 ratio.


Hypertensive intracerebral hemorrhage (HICH) is the most common hemorrhagic stroke. The morbidity and mortality exceed 60% and only 12% patients could live independently. The choice of surgical or conservative treatment for patients with HICH is controversial.

Some minimally invasive neurosurgeries have been applied to hematoma evacuation and may improve prognosis to some extent. In endoscopic evacuation, a small burr hole is created and hematoma is removed through suction and irrigation under neuroendoscope. Endoscopic surgical evacuation promise to maximize hematoma evacuation while minimizing damage to normal tissue. Stereotactic aspiration uses image guidance to place a catheter into the main body of the hematoma and aspirate blood. In this study, about 900 patients will receive endoscopic evacuation, stereotactic aspiration or craniotomy according to the results of randomization. Patients will be followed up at 7 days, 30 days and 6 months.

Outcomes of different groups of patients will be collected and compared. The study is designed to find a best surgical method for hypertensive intracerebral hemorrhage.

Condition Intracranial Hemorrhage, Hypertensive
Treatment Endoscopic Evacuation, Stereotactic Aspiration, Craniotomy, Craniotomy
Clinical Study IdentifierNCT02811614
SponsorChinese PLA General Hospital
Last Modified on25 January 2021


Yes No Not Sure

Inclusion Criteria

Supratentorial hypertensive intracerebral hemorrhage on CT scan with the hematoma volume >20mL
Adult patients with GCS score 5
Admitted within 24h of ictus

Exclusion Criteria

Intracerebral hemorrhage caused by tumor, coagulopathy, aneurysm, or arteriovenous malformation
Concurrent head injury or history of head injury
Multiple intracerebral hemorrhage
Known advanced demential or disability before
With indications of terminal brain hernia
Severe concomitant diseases that affect life expectancy
Patients having taken anti-platelet or anticoagulant drugs for a long time
With severe intraventricular hemorrhage
Pregnant women
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