Microsurgical treatment of hypertensive basal ganglia hematomas through transsylvian-transin-sular approach

Abstract

Objective To study the surgical experience and clinical efficacy of microsurgical treatment on patients with hypertensive basal ganglia hematomas through transsylvian-transinsular approach. Methods A retrospective analysis was performed on 68 consecutive patients with hypertensive basal ganglia hematomas who underwent surgical treatment at Department of Neurosurgery, Shanxi Dayi Hospital from June 2013 to May 2018. All of them were operated on for hematomas evacuation through transsylvian-transinsular approach.The degree of hematomas evacuation was evaluated by postoperative CT scan results. Glasgow outcome scale (GOS) was used to access the clinical prognosis. Results The volume of remaining hematoma was 0-10 ml (median: 3.5±0.5 ml) on CT scan obtained 24 hours postoperatively. In this group, near complete (>90%) evacuation was achieved in 83.8%(57/68), 70-90% in 8.8% (6/68) and less than 70% in 7.4% (5/68). None of the patients had edema or contusion around the surgical corridor. There were rebleeding in 1 (1.5%) case, severe pulmonary infection in 6, intracranial infection in 3, hydrocephalus in 2 and epilepsy in 1. The mortality rate was 4.4% (3/68). There was 42 cases with good function, 18 cases with disability, and 5 cases in vegetative state at 6 months post surgery among 65 surviving patients. Conclusions Microsurgery through transsylvian-transinsular approach is one of safe and effective treatments for hypertensive basal ganglia hematomas. Keeping proper dissection plane is crucial to preserve the veins during the sylvian dissection. It could offer a sufficiently wide surgical corridor to evacuate the hematomas. Key words: Intracranial hemorrhage, hypertensive; Basal ganglia; Transsylvian-transinsular approach; Treatment outcome