MATERIAL and METHODS: One hundred-eighty-four elderly patients with HCH, who had craniotomy indications after conservative treatment for 6-24 hours after onset, were randomly divided into two groups. In the craniotomy group, traditional hematoma drainage was performed. In the keyhole group, an endoscope-assisted keyhole technique was used. Anesthesia time, blood loss, hematoma drainage rate, and complications were compared. The clinical primary outcome was the six-month efficacy rate (defined by the activities of daily living (ADL) score).

RESULTS: Anesthesia time was longer in the craniotomy group (3.43±0.65 vs. 1.53±0.52 h, P<0.01), and blood losses were more important (256±129 vs. 96±39 ml P<0.01). There was no difference in hematoma drainage rate between the two groups (77.25±13.44 vs. 83.52±27.51% P>0.05). Complications, including tracheotomy (P<0.01), pulmonary infection (P<0.01) and hypoproteinemia (P<0.05) were more frequent in the craniotomy group. There was no difference in the occurrence of other complications, including revision surgery digestive tract ulcer and epilepsy. Proportion of patients with good prognosis (ADL I-III) was larger in the keyhole group (P<0.05).

CONCLUSION: In elderly HCH patients with an indication for hematoma drainage, better outcomes were achieved using an endoscope-assisted keyhole technique. Keywords : Hypertensive cerebral hemorrhage, Elderly, Endoscopy, Minimally invasive approach