{
  "abstract": "Background Intracerebral hemorrhage (ICH) is a common stroke subtype with high morbidity and mortality. The optimal surgical approach remains unclear. This study compared the efficacy and cost-effectiveness of three minimally invasive surgeries—endoscopic surgery, frameless navigated aspiration, and small-bone flap craniotomy—in patients with hypertensive basal ganglia ICH.Methods In this parallel-group, multicenter randomized trial at 16 centers (July 2016 to June 2022), 515 patients were randomly assigned to endoscopic surgery (n=169), navigated aspiration (n=177), or craniotomy (n=169). The primary outcome was favorable functional outcome (modified Rankin Scale 0–2) at 6 months. Economic evaluation included hospitalization costs and quality-adjusted life years (QALYs).Results Among the 515 enrolled patients, 468 completed the 6-month follow-up. Favorable outcomes occurred in 29.7% (46/155) of the endoscopy group, 28.1% (45/160) of the aspiration group, and 15.7% (24/153) of the craniotomy group (P=0.007). Mean hospitalization costs were ¥91 517 ($12 853), ¥77 786 ($10 925), and ¥101 208 ($14 214), respectively (P<0.001). Endoscopy produced an incremental QALY gain of 0.0665 with cost savings of ¥13 660 ($1919) versus craniotomy, while aspiration achieved a QALY gain of 0.0545 and cost savings of ¥29 423 ($4132), indicating dominance for both minimally invasive strategies.Conclusions For patients with hypertensive basal ganglia ICH, both endoscopic surgery and frameless navigated aspiration can improve long-term outcomes compared with small-bone flap craniotomy, while also reducing medical costs. Among the three treatments, aspiration provided the most favorable incremental cost-effectiveness profile.Trial registration number NCT02811614.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China"
      ],
      "name": "Xinghua Xu"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China"
      ],
      "name": "Jiashu Zhang"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Jingzhou Central Hospital, Jingzhou, People's Republic of China",
        "Department of Neurosurgery, Jingzhou Hospital Affiliated to Yangze University, Jingzhou, People's Republic of China"
      ],
      "name": "Huaping Zhang"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China",
        "Medical School of Chinese PLA, Beijing, People's Republic of China"
      ],
      "name": "Qingzhen Yuan"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China"
      ],
      "name": "Qun Wang"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China"
      ],
      "name": "Zhichao Gan"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Wuhan No.1 Hospital, Wuhan, China"
      ],
      "name": "Ming Luo"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China"
      ],
      "name": "Xiaolei Chen"
    }
  ],
  "title": "Efficacy and cost-effectiveness analysis of minimally invasive surgeries for basal ganglia hypertensive intracerebral hemorrhage",
  "uid": "97dd4685-aced-544a-9f3f-fd2c4480cdbf"
}