Optimal Timing for Stereotactic Minimally Invasive Surgery in Supratentorial Spontaneous Intracerebral Hemorrhage With Tentorial Herniation: A Retrospective Study.

OBJECTIVE: To investigate the optimal timing of stereotactic minimally invasive surgery (SMIS) in individuals with supratentorial intracerebral hemorrhage (sICH) and brain herniation. METHOD: A retrospective analysis was conducted on patients with sICH and brain herniation who underwent SMIS in the emergency department of the Affiliated Hospital of Guizhou Medical University between January 2019 and October 2024. The patients were categorized into three groups based on the time from the onset of brain herniation to receiving SMIS: ≤6-h group (112 cases), 6-12-h group (57 cases), and >12-h group (32 cases). All enrolled patients were monitored over a 6-month period, and their prognoses were assessed using the Glasgow Outcome Scale Extended (GOSE), which was used for grouping. Clinical data, imaging findings, complications, comorbidities, infection markers, and outcome data were collected and analyzed comprehensively. Detailed analyses and comparisons were performed based on GOSE scores, Modified Rankin Scale (mRS) scores, and survival rates at 1, 3, and 6 months after sICH. Patients with mRS scores of 1-3 and GOSE scores of 4-8 had favorable outcomes. A detailed analysis of the six-month survival rate and post-treatment functional outcomes was conducted to draw research conclusions. RESULT: This study included 201 patients. At 6 months sICH, the mRS scores were 3.71 ± 1.30 for the ≤6-h group, 4.61 ± 1.25 for the 6-12-h group, and 4.18 ± 1.35 for the >12-h group, with the ≤6-h group showing markedly higher scores (p < 0.001). The GOSE scores at 6 months postoperatively were 4.05 ± 1.73 for the ≤6-h group, 3.05 ± 1.76 for the 6-12-h group, and 3.19 ± 1.73 for the >12-h group, with the ≤6-h group showed markedly higher scores (p = 0.001). The proportion of favorable outcomes at 6 months postoperatively was 47.3% for the ≤6-h group, 24.6% for the 6-12-h group, and 18.8% for the >12-h group, with the proportion of favorable outcomes highest in the ≤6-h group (p = 0.001). The Kaplan-Meier survival curve showed that the survival rate of the ≤6-h group was 80.4%, which was significantly higher than the 57.9% of the 6-12-h group and the 65.6% of the >12-h group (F = 10.060, p = 0.007). CONCLUSION: Undergoing SMIS intracranial hematoma evacuation within 6 h of brain herniation onset can effectively reduce neurological damage, significantly improve survival rates, and provide favorable prognosis.