Multimodal image fusion-assisted endoscopic evacuation of spontaneous intracerebral hemorrhage

Although traditional craniotomy (TC) surgery has failed to show benefits for the functional outcome of intracerebral hemorrhage (ICH). However, a minimally invasive hematoma removal plan to avoid white matter fiber damage may be a safer and more feasible surgical approach, which may improve the prognosis of ICH. We conducted a historial cohort study on the use of multimodal image fusion-assisted neuroendoscopic surgery (MINS) for the treatment of intracerebral hemorrhage, and compared its safety and effectiveness with traditional methods. This is a historial cohort study involing 241 patients with cerebral hemorrhage. Divided into MINS group and TC group based on surgical methods. Multimodal images (CT skull, computed tomography angiography, and white matter fiber of MRI diffusion-tensor imaging) were fused into three dimensional images for preoperative planning and intraoperative guidance of endoscopic hematoma removal in the MINS group. Clinical features, operative efficiency, perioperative complications, and prognoses between 2 groups were compared. A total of 42 patients with ICH were enrolled, who underwent traditional craniotomy surgery and multimodal image fusion assisted neuroendoscopic surgery. Patients who underwent MINS had shorter operative time (p < 0.001), less blood loss (p < 0.001), better hematoma evacuation (p = 0.003), and a shorter stay in the intensive care unit (p = 0.002) than patients who underwent TC. Based on clinical characteristics and analysis of perioperative complications, there is no significant difference between the 2 surgical methods. Modified Rankin Scale scores at 180 days were better in the MINS than in the TC group (p = 0.014). Compared with traditional craniotomy for the treatment of intracerebral hemorrhage, multimodal image fusion-assisted neuroendoscopic surgery is safer and more efficient in clearing intracerebral hemorrhage, which seems to improve the prognosis of patients with intracerebral hemorrhage. In the future, a larger sample size clinical trial will be needed to evaluate its efficacy.