Effect of intracranial pressure monitoring-based therapy on clinical efficacy and serum levels in neurosurgical patients with severe intracerebral hemorrhage

Abstract

Objective To investigate the effect of intracranial pressure (ICP) monitoring combined with hematoma evacuation on clinical efficacy and serum markers in neurosurgical patients with severe intracerebral hemorrhage. Methods A total of 120 patients with severe intracerebral hemorrhage treated in the Department of Neurology, Taihe Hospital, Hubei University of Medicine from January 2025 to January 2026 were retrospectively enrolled. According to whether postoperative ICP monitoring was performed, the patients were divided into an ICP monitoring group (hematoma evacuation + external ventricular drain-based ICP monitoring) and a control group (hematoma evacuation alone). Propensity score matching at a 1:1 ratio was used to balance baseline characteristics, and 57 patients were ultimately included in each group. The surgical indicators, 3-month favorable outcome defined as Glasgow Outcome Scale score 4–5, neurological deficit scores, serum levels of endothelin-1 (ET-1), matrix metalloproteinase-9 (MMP-9), advanced oxidation protein products (AOPP), cortisol (Cor), and norepinephrine (NE), activity of daily living (ADL) score, and complication rates were compared between the two groups. Results After matching, there were no significant differences in intraoperative blood loss and evacuated hematoma volume between the two groups (both p > 0.05). The operation time of the ICP monitoring group was longer than that of the control group (p < 0.05), while the hematoma evacuation time and hospital stay were significantly shorter (both p < 0.05). The 3-month favorable outcome rate in the ICP monitoring group was 87.72% (50/57), which was significantly higher than 49.12% (28/57) in the control group (p < 0.05). After treatment, the Chinese Stroke Scale (CSS) scores and National Institutes of Health Stroke Scale (NIHSS) scores in the ICP monitoring group were both lower than those in the control group (both p < 0.05); the serum levels of ET-1, MMP-9, AOPP, Cor, and NE in the ICP monitoring group were also significantly lower than those in the control group (all p < 0.05). The ADL score of the ICP monitoring group was significantly higher than that of the control group (p < 0.05). The overall complication rate was 7.02% (4/57) in the ICP monitoring group, which was significantly lower than 22.81% (13/57) in the control group (p < 0.05). Conclusion Intracranial pressure monitoring combined with hematoma evacuation was associated with better clinical outcome, lower serum levels of ET-1, MMP-9, AOPP, and stress hormones, fewer complications, and greater independence in daily living. However, the observational design limits causal inference, and the external ventricular drain may have contributed both monitoring and therapeutic drainage effects that cannot be completely separated in this study.