Early microsurgery via transsylvian-transinsular approach in hypertensive intracerebral hematomas in the basal ganglia

Abstract

Objective To investigate the clinical value of early microsurgery of hypertensive intracerebral hematomas in the basal ganglia via transsylvian-transinsular and cortical fistula approach. Methods A retrospective study was performed on 122 cases of patients with hypertensive intracerebral hematomas in the basal ganglia who were admitted from January 2013 to December 2016.According to different surgical approaches, the patients were divided into the cortical fistula approach (CFA) group and the transsylvian-transinsular approach (TTA) group.In the CFA group, the ipsilateral left middle temporal gyrus was used as the hematoma cavity; in the TTA group, the ipsilateral lateral fissure and the upper lobe of the insular cortex reached the hematoma cavity.After the operation, the patients were examined by brain CT to determine the clearance rate of the hematoma, and the NICU admission time and the daily living ability score were compared between the two groups. Results The differences of postoperative hematoma clearance rate, NICU admission time and ADL between the two groups were statistically significant (P<0.05). Conclusion Compared with the cortical fistula approach, the transsylvian-transinsular approach has higher hematoma clearance rate, shorter NICU admission time and better prognosis, which is worth of clinical promotion. Key words: Transsylvian-transinsular approach; Cortical fistula approach; Microsurgery; Hypertension; Intracerebral hematoma; Basal ganglia