Hypertensive Basal Ganglia Hemorrhage Research Articles

The Application Effect of Craniotomy through Transsylvian Rolandic Point-Insular Approach on Hypertensive Intracerebral Hemorrhage in Posterior Basal Ganglia

Objective. To evaluate the hematoma clearance and safety of small bone window craniotomy through the lateral fissure Rolandic point-insular lobe approach for patients with hypertensive intracerebral hemorrhage (HICH) in posterior basal ganglia. Methods. This retrospective study enrolled a total of 86 patients with HICH in the posterior basal ganglia region who underwent surgery between January 2020 and December 2021. These patients were divided into two groups: the conventional group and the study group. The intraoperative information, postoperative hematoma clearance rate, increasing rate of cerebral edema and rebleeding occurrence rate, postoperative complication rate, and prognoses were compared between the two groups. Additionally, we observed and compared the rate of postoperative cerebral hematoma increase, as well as the neurological function and activities of daily living (ADL) at admission, 3 months, and 6 months after surgery in both groups. Univariate and multivariate logistic regression analyses were performed to explore factors affecting the prognosis of patients with HICH in the posterior basal ganglia region after small bone window craniotomy through the lateral fissure Rolandic point-insular lobe approach. Results. The study group exhibited significantly shorter automatic eye-opening times and hospital stays compared to the conventional group ( P < 0.05 ). Furthermore, the study group demonstrated better hematoma clearance rates, lower rates of cerebral hematoma at postoperative 48 h and 72 h, and lower rates of rebleeding compared to the conventional group ( P < 0.05 ). At 3 and 6 months postsurgery, the study group exhibited a significantly greater improvement in neurological function and ADL compared to the conventional group ( P < 0.05 ). Additionally, the incidence of postoperative complications in the study group was lower than that in the conventional group ( P < 0.05 ). Furthermore, the prognosis of the study group was significantly better than that of the conventional group at the 6-month follow-up ( P < 0.05 ). Conclusion. A small bone window craniotomy via transsylvian Rolandic point-insular approach has been shown to improve the hematoma clearance rate in patients with HICH in the posterior basal ganglia region while also reducing the incidence of complications. This approach is highly safe and feasible for implementation in clinical practice.

Endoport Assisted Endoscopic Surgery for Hypertensive Basal Ganglia Hemorrhage by Transsylvian Approach: Technical Nuances and Preliminary Clinical Results

There is no clear evidence on the indication and surgical approaches on evacuating basal ganglia hemorrhage caused by hypertensive bleeding. Some studies have shown that minimally invasive approaches have therapeutic potentials, but its benefits remain inconclusive. We describe an endoport assisted endoscopic transsylvian approach for basal ganglia hemorrhage evacuation. We evaluate the safety and efficacy of this approach in a cohort study. We included 19 patients (mean age 57years) who underwent the surgery at a single county-level hospital in Yunan Province, China. The majority had a Glasgow coma scale between 9 and 12 on admission. The midline shift ranged from 16-29mm (mean 19mm). Hematoma volume ranged from 46 to 106ml (mean 67ml). Six patients (31.6%) presented with intraventricular hemorrhage. All patients achieved greater than 90% decrease in hematoma volume at postoperative computed tomography scan. The average operative time was 115 minutes and average blood loss of 44ml. The most common postoperative complication was pulmonary infection (63.2%). No rebleeding, seizure, infectious meningitis, or postoperative mortality was observed. A total of 17 patients (89.5%) achieved good functional recovery at follow up within 90days after surgery (Glasgow outcome scale 4-5) and 2 patients had severe disability (Glasgow outcome scale 3). Endoport assisted endoscopic surgery through transsylvian approach is safe and effective treatment for hypertensive basal ganglia hemorrhage. The majority of patients have good functional recovery and the rate of severe complications is low.

Smartphone navigated endoscopic port surgery of hypertensive basal ganglia hemorrhage

ObjectiveEndoscopic port surgery is a promising alternative for the surgical treatment of intracerebral hypertensive basal ganglia hemorrhage (HBGH). The precise location of hematoma is a crucial step for surgery. The authors developed a simple, low-cost navigation method using an Android smartphone for the localization of HBGH. MethodsAll patients’ CT DICOM data were processed with an open-source software (3D Slicer). The volume of hematoma, angle, and length of trajectory were calculated automatically. A smartphone running the Android system and the Compass APP was used to help insert the inner introducer. An endoscopic port system was applied to create a working channel for neuro-endoscopic hematoma evacuation. ResultsThere were 27 patients enrolled in this study (mean age 56). All patients underwent successful surgical evacuation of HBGH with neuroendoscopic evacuation. The mean time taken for the surgical plan was 4 min. The total operation time from skin incision to final suture was 82.6 min. Compared with standard neuronavigation, mean error of trajectory was 5.1 mm. The mean preoperative hematoma volume was 44.8 ml. The optimal trajectory angle averaged 39.5°and the length was 71 mm. Intraoperative blood loss was about 45 ml. Post-operative hematoma volume was 2.9 ml, and the average evacuation rate was 93.6%. One week after surgery, the mean GCS score was improved from 8.2 to 13.8 (p < 0.01). ConclusionsThis simple, low-cost navigation method using 3D Slicer, an Android smartphone with the Compass APP, helps precisely insert the endoscopic working channel to the desired point, which is crucial for satisfactory evacuation of HBGH.

Clinical Study on a Modified Hematoma Puncture Drainage Treatment in Patients with Hypertensive Basal Ganglia Hemorrhage

We aim to investigate the clinical efficacy and safety of a modified hematoma puncture drainage treatment through the burr hole lateral to Kocher's point from the frontal lobe in patients with hypertensive basal ganglia hemorrhage. Twenty-six patients were enrolled in the retrospective study. The volume of hematoma in those patients was between 25 and 35mL, and the Glasgow Coma Scale scores were between 9 and 11; they were divided into a hematoma puncture drainage treatment group and a traditional conservative treatment group. The volume of remaining hematoma, neurological function defect scores, and life quality after treatment, duration of hospitalization, and cost of hospitalization were analyzed in these 2 groups. The volume of remaining hematoma was significantly less in the drainage group than that in the traditional group on the first day and the third day after treatment (P < 0.05). Posttreatment neurological function defect scores in the drainage group were statistically lower than those in the traditional group (P < 0.05). The duration of hospitalization was significantly shorter and the cost of hospitalization was also significantly less in the drainage group than that in the traditional group (P < 0.05). The Extended Glasgow Outcome Scale and Barthel Index scores were significantly higher in the drainage group than those in the traditional group (P < 0.05). There were no significant differences between the 2 groups in the complication rates (P > 0.05). The modified hematoma puncture drainage treatment represents an effective and safe way to treat hypertensive basal ganglia hemorrhage.

Analysis of Efficacy and Safety of Modified Transfrontal Puncture Drainage in Hypertensive Basal Ganglia Hemorrhage Patients.

ObjectiveThe study aimed to explore the efficacy and safety of modified transfrontal puncture drainage in patients with hypertensive basal ganglia hemorrhage.MethodsThe study enrolled 102 patients with hypertensive basal ganglia hemorrhage who received treatment at our hospital between April 2020 and June 2020. They were divided into a control group (51 cases, burr hole evacuation of intracranial hematoma) and a study group (51 cases, modified transfrontal puncture drainage) using the random number table method. The operative time, hematoma evacuation rate, time to recovery of consciousness, postoperative Glasgow coma scales (GOS), and the length of hospital stay were compared between the two groups. The postoperative recovery of neurological function in the two groups was observed, and activities of daily living at 3 months postoperatively in the two groups were statistically analyzed. The postoperative complications and recurrent bleeding, as well as prognosis in the two groups, were recorded.ResultsThe operative time, hematoma evacuation rate, time to recovery of consciousness, postoperative GOS scores, time to extubation, and the length of hospital stay of the two groups were compared postoperatively, and the difference was statistically significant (p < 0.05). The preoperative neurological function of the two groups was compared, and the difference was statistically insignificant (P > 0.05). The postoperative neurological function of the study group was lower than that of the control group, and the difference was statistically significant (P < 0.05). The postoperative incidence of stress ulcer, renal failure, and recurrent bleeding in the two groups was compared, and the difference was statistically insignificant (p > 0.05). The rate of pulmonary infections and gastrointestinal bleeding in the study group was lower than that of the control group, and the difference was statistically significant (P < 0.05). The mortality rate of the study group was 1.96% (1/51) and that of the control group was 3.92% (2/51), and the difference was statistically insignificant (p > 0.05). The activities of daily living in the two groups were compared and the difference was statistically insignificant (p > 0.05).ConclusionModified transfrontal puncture drainage can effectively treat hypertensive basal ganglia hemorrhage patients and has relatively good safety.

Application of neuroendoscopic surgery in treatment of hypertensive basal ganglia hemorrhage.

The influence of Application of neuroendoscopic surgery in treatment of hypertensive basal ganglia hemorrhage remains largely unknown. To compare the clinical efficacy of minimally invasive neuroendoscopic surgery (NES) and small bone window craniotomy (SBWC) microsurgery on the treatment of patients with hypertensive basal ganglia hemorrhage (HBGH). The clinical data of 174 HBGH patients treated in our hospital from January 2018 to September 2020 were retrospectively analyzed. They were divided into minimally invasive NES group (n = 90) and SBWC microsurgery group (n = 84). Their operation time, hematoma clearance rate, rebleeding and prognosis were compared. In minimally invasive NES group, the operation time and intraoperative hemostasis time were significantly shorter, and the intraoperative blood loss was significantly less than those in SBWC microsurgery group (p menor de 0.001). The preoperative Glasgow coma scale (GCS) score was 8.64 ± 1.04 points and 8.68 ± 1.02 points respectively in minimally invasive NES group and SBWC microsurgery group (p mayor de 0.05). At 24 h after operation, the GCS score in minimally invasive NES group rose to 12.89 ± 1.56 points, and it had a significant difference from that in SBWC microsurgery group (11.18 ± 1.14 points, p menor de 0.001). The volume of brain edema was 11.82 ± 3.25 mL in minimally invasive NES group and 18.89 ± 3.15 mL in SBWC microsurgery group (p menor de 0.001). In minimally invasive NES group, the clearance of hematoma was superior to that in SBWC microsurgery group, and the prognosis was also better than that in SBWC microsurgery group. Minimally invasive NES has better efficacy than SBWC microsurgery in the treatment of HBGH.

A Keyhole Approach Centered by Anterior Squamous Suture to Hypertensive Basal Ganglia Hemorrhage.

This study aimed to improve the accuracy and efficacy of the keyhole transsylvian approach to remove hypertensive basal ganglia hemorrhage. The authors presented a stable keyhole craniotomy based on anterior squamous suture to expose insular cortex and basal ganglia. Twenty-nine patients with hypertensive basal ganglia hemorrhage were treated with keyhole surgery and studied in Guangdong sanjiu brain hospital. By using a bone suture marked keyhole transsylvian approach, near-complete (90%) hematoma evacuation was achieved in 21 cases (72.4), 70% to 90% in 8 cases (24.1), and less than 70% in 1 case (3.4%). In our cohort, 55.1% (16/29) with good function (GOS score 4-5), 41.3% (12/29) with disability (GOS score 3), and 3.4% (1/29) in a vegetative state (GOS score 2). No patients died within 6 months of operation. Our method can greatly minimize the bone exposure and precisely located the distal Sylvian fissure. A stable keyhole craniotomy based on bone suture can be identically safe and effective in comparison with classic surgery, and it consumes less time and less intra-operative bleeding.

The Clinical Efficacy of Electromagnetic Navigation-Guided Hematoma Puncture Drainage in Patients with Hypertensive Basal Ganglia Hemorrhage

To investigate the clinical efficacy of navigation-guided minimally invasive surgery in patients with hypertensive basal ganglia hemorrhage. A total of 64 patients with hypertensive basal ganglia hemorrhage were enrolled in this retrospective study. They were divided into a navigation group and a traditional group based on surgical approaches. The data for the 2 groups of patients were analyzed with regard for the hematoma clearance rate, duration of surgery, duration of hospitalization, Glasgow Outcome Scale score at discharge, Barthel index score at 6 months, and postoperative complication rates for rebleeding and pneumonia. There were no significant differences in basic characteristics between the 2 groups (P > 0.05). The hematoma clearance rate was significantly lower in the navigation group (49.18 ± 16.76%) than in the traditional group (84.29 ± 6.91%, P < 0.01). The duration of surgery and duration of hospitalization were significantly shorter in the navigation group (55.00 ± 11.89 minutes and 24.25 ± 7.1 days, respectively) than in the traditional group (156.38 ± 47.9 minutes and 32.63 ± 9.8 days, respectively; both P < 0.01). There were also significant differences between the 2 groups in Glasgow Outcome Scale scores (P= 0.006). The Barthel index scores were significantly greater in the navigation group (73.13 ± 18.76) than in the traditional group (57.63 ± 26.63, P < 0.05). There were no significant differences between the 2 groups in the complication rates (P > 0.05). Under certain conditions, compared with standard craniotomy and hematoma evacuation, navigation-guided hematoma puncture aspiration and catheter drainage is simple, effective, and safe as a treatment for hypertensive basal ganglia hemorrhage.

Supernumerary phantom limb in a patient with basal ganglia hemorrhage - a case report and review of the literature

BackgroundSupernumerary phantom limb (SPL) is a rare neurologic phenomenon, in which a patient misperceives an extra limb in addition to the original set of limbs. We report a case of SPL in a patient with a right basal ganglia hemorrhage and review the previous literature about this peculiar phenomenon.Case presentationTwo days after the event of a right basal ganglia hemorrhage, a 78-year-old male reported a phantom arm protruding from his left shoulder. He could not see or touch the phantom arm but he felt the presence of an addition arm lateral to his paretic arm. Pain or sensory discomfort were absent in either the paretic arm or the phantom arm. He stated that he could intentionally move the phantom arm independent of his paretic arm. The examination showed that the passive movement of his paretic arm did not elicit any movement of his phantom arm. We diagnosed the SPL as a complication of the hypertensive basal ganglia hemorrhage and treated him with anti-hypertensive medications. His phantom arm persisted for 3 weeks, and it gradually faded away.ConclusionSPL had been reported as a rare complication of various types of cerebral lesions. Right hemispheric lesions were most frequently associated with the SPL. Considering the intentional movement of the phantom arm, we deduced that the SPL might result from the impairment of the sensory feedback system for both internal body image and motor movement.

Efficacy comparison of different surgical timing and approaches of hypertensive cerebral hemorrhage in the basal ganglia

Objective To investigate the effects of surgical timing and approaches on the treatment outcomes of hypertensive cerebral hemorrhage in the basal ganglia. Methods The clinical data of 223 patients with hypertensive cerebral hemorrhage in the basal ganglia, who underwent operations at Department of Neurosurgery, the People's Hospital of Xinjiang Uygur Autonomous Region from January 2010 to September 2015, were retrospectively analyzed. Based on the time from illness onset to surgery, these patients were divided into 3 groups: the ultra-early group (≤ 7 h, n=75), early group(> 7-24 h, n=109), and delayed group (> 24 h, n=39). According to different surgical approaches, patients were also divided into 2 groups including the craniotomy group in which 107 cases were treated with craniotomy with bone flap and minimally invasive group in which 116 patients underwent minimally invasive puncture and drainage. Evaluation with the activities of daily living (ADL) grade was conducted at 7 days and 3 month post surgery for all patients. Results The modified ADL scores demonstrated that the excellent rate at 7 days post surgery in the ultra-early group was 89.3% and significantly higher than those in the early group (62.3%) and delayed group (56.4%) (both P 0.05). Conclusions The prognosis of patients with hypertensive hemorrhage in the basal ganglia undergoing ultra-early surgical management seems to be better than those undergoing early or delayed operations. The treatment of craniotomy could lead to better perioperative periool outcomes and similar short-term results compared with the minimally invasive procedure for hematoma removal. Key words: Hypertensive cerebral hemorrhage; Basal ganglia; Prognosis; Timing of surgery; Surgical approach

The clinical application of retractorless surgery in patients with hypertensive basal ganglia hemorrhage

Objective: To discuss the clinical feasibility and practical application of retractorless surgical for patients with hypertensive basal ganglia hemorrhage. Methods: A total of 84 patients underwentretractorless surgery in The First People's Hospital of Huzhou from Jun 2014 to Jun 2016 were retrospectively reviewed.There were 53 male and 31 female of the 84 patients. Their mean age were 58.7 years with range: 29-74 years.Glasgow coma scale score(GCS) at admissionwereas follow: GCS 4-5 points 10 cases(including 3 cases companied dilated pupils), GCS 6-8 points 25 cases, GCS 9-12 points 32 cases, and GCS 13-14 points 17 cases.The average volume of hematoma was 50.2 (30-100) mL.Complications related tosurgery and postoperative activities of daily living (ADL) scorewere analyzed. Results: 0f the 84 cases, there were 76 (90.5%) patientswhose intracranial hematoma were removed more than 90%. Postoperative bleeding was occurred in 6 cases (7.1%), all without secondary surgery. Cerebral infarctionwas occurred in 2 cases (2.4%), subcutaneous effusion associated with infectionwas occurred in 7 cases (8.3%). Postoperative follow-up of 58 cases, 85.3% recovered well. Conclusions: With the proficiency in microneurosurgery methods, retractorless surgery couldreduce the related postoperative complications, such as postoperative cerebral infarction.

Endoscopic surgery versus microsurgery in treating hypertensive basal ganglia hemorrhage: A meta-analysis

Objective To compare the clinical efficacy of neuroendoscopy and microsurgery for the treatment of hypertensive basal ganglia hemorrhage. Methods PubMed, Cochrane Library, Embase, VIP, CNKI, CBM and Wanfang database were retrieved. The randomized controlled trials and semi-randomized controlled trials comparing all the basal ganglia hemorrhage treated with neuroendoscopy and microsurgery were searched. The retrieval time was from the establishment of the database to October 31, 2015. After the detected literature being screened, extracted and evaluated, a Meta-analysis was performed using RevMan 5.3 software, and the GRADE system was used to conduct the quality evaluation of evidence. Results Finally, A total of 9 trials with 700 patients were enrolled. The results of Meta-analysis showed: (1) in the aspect of safety: compared with the microscope group, the hematoma clearance rate was higher (SMD=0.63, 95% CI 0.30-0.95, P<0.001), operation time was shorter (SMD= -2.66, 95% CI -3.71- -1.60, P<0.001), hospitalization time was shorter (SMD=-0.72, 95% CI -1.01- -0.44, P<0.001), and postoperative complications were less (RR=0.56, 95% CI 0.40-0.77, P<0.001) of the neuroendoscopy group. There were no significant differences in the intraoperative bleeding and hospital cost between the 2 groups (all P<0.05). (2) In the aspect of effectiveness: compared with the microsurgery group, the prognosis was better (RR=1.15, 95% CI 1.03-1.27; P=0.002) and the mortality was lower (RR=0.57, 95% CI 0.22-1.00; P=0.05) in the neuroendoscope group. Conclusions Compared with the microsurgery, the prognosis of neuroendoscopy is better, the mortality is lower, the efficacy is better, and the surgical removal rate of the latter is higher, the operation time is shorter, the postoperative complications are less, and the safety is higher. But because of the quality of the original research is lower, the prudent choice and use in clinical practice ARE recommended. More high quality, large sample randomized controlled trials are needed for further argument. Key words: Intracranial hemorrhage, hypertensive; Neuroendoscopy; Microsurgery; Treatment outcome; Meta-analysis

Decompressive Hemicraniectomy in Hypertensive Basal Ganglia Hemorrhages

Objectives: The aim of this study was to analyze efficacy and safety of decompressive hemicraniectomy (DHC) in hypertensive basal ganglia hemorrhage (HBGH). Neurosurgical management of HBGH is still a controversial issue. Surgical techniques are diverse, from the open large craniotomy, to the minimally invasive techniques like stereotactic aspiration of the HBGH, endoscopic evacuation and stereotactic catheter drainage after instillation of thrombolytic agents. Decompressive hemicraniectomy lowers intracranial pressure and improves outcome in patients with HBGH.Methods: 8 patients with HBGH who underwent decompressive craniectomy in the last 2 years were analyzed. Parameters investigated included clinical presentations, radiologic profile, time interval from ictus to surgery, and modified Rankin Scale score at 6 months.Results: The patients mean age 55 years, the mean Glasgow Coma Scale (GCS) score was 7 (range 5–13), the mean ICH volume was 58 ml (range 40–70 ml), and the mean midline shift was 10.62 mm (range 6-16 mm). The outcome after 6 months was appreciated as good (modified Rankin Scale 0–4) or poor (modified Rankin Scale 5-6). Five patients had good and three had poor outcomes (including two deaths).Conclusion: We conclude, based on this small cohort, that DC can reduce mortality in some cases. Larger prospective studies are needed to assess safety and efficacy of this method.Pulse Vol.8 January-December 2015 p.38-42

Effect of operation time on efficacy for patients with hypertensive basal ganglia hemorrhage

Two hundred and twenty patients with hypertensive basal ganglia hemorrhage(HBGH)undergoing cranial drilling operation and placement of soft catheter for drainage were enrolled. Among all patiems, the operation was performed at ≤6 h of disease onset in 92 cases (ultra-early group) , 6-24 h in 74 cases (early group) and >24 h in 54 cases (selective group). The surgery-related complications, near-term outcome and long-term outcome were compared among three groups. In ultra-early group, recurrent hemorrhage was observed in 26 cases (28%), which was higher than that in other two groups. In selective group, there were 11 cases (20 %) of well recovered, 19 cases (35%) of moderate deformity, 16 cases (30%) of severe deformity, 5 cases(9%)of vegetative state and 3 fatal cases(6%)indicating that the near-term outcome was worse than those other two groups . However there was no significant difference in long-term outcome among three groups. The rapid minimal invasive cranial drilling and soft catheter drainage is a safe and effective operation for HBGH patients and the optimal time for operation is 6-24 hours. Key words: Cerebral hemorrhage, basal ganglia; Rapid pore cranial drilling; Operation time

Clinical experience of individual surgical therapy in hypertensive basal ganglia hemorrhage.

The aim of this article is to summarize the clinical experience stemming from the administration of different surgical therapies in hypertensive basal ganglia hemorrhage (HBGH) patients. A series of 87 patients with HBGH who had received surgical therapy individually were enrolled in this study. The surgical therapies were stereotactic aspiration (SA), stereotactic aspiration plus fibrinolytic therapy (SA+F) and microsurgery with small bone window (MS), respectively. The outcomes of the patients were evaluated by evolution of hematoma evacuation, activities of daily living (ADL) scale, mortality and complications. We found that there was no significant difference in the 24-hour evacuation rate, mortality and complication rate among treated groups (P>0.05). Though patients in level III and level IV of ADL scores were significantly different among the three groups, the overall ADL scale result demonstrated a similar ADL result. HBGH patients should be treated with an individualized surgical approach based on their condition and on the CT morphology of the hematoma.

Effect of Xingnaojing injection combined with minimally invasive percutaneous drainage in treating brain edema and content of serum AQP4 in patients with moderate hypertensive basal ganglia hemorrhage

To observe the effect of Xingnaojing Injection combined with minimally invasive percutaneous drainage on brain edema and content of serum aquaporin-4 (AQP4) in patients with moderate hypertensive basal ganglia hemorrhage, and discuss the treatment mechanism of Xingnaojing injection combined with minimally invasive percutaneous drainage for cerebral hemorrhage. Forty-two patients with moderate (25-50 mL) hypertensive basal ganglia hemorrhage (< 24 h) were selected and randomly divided into two groups: the observation group (n = 22) and the control group (n = 20). The neurological severity score were evaluated by the NIHSS (national institutes of health stroke scale), the volume of brain edemas were measured by head CT, the serum levels of AQP4 were determined by ELISA method on admission and 1 and 2 weeks after treatment. On admission, there was no significant difference in the scores of NIHSS, the volume of brain edemas and the level of serum AQP4 between the observation group and the control group. At the end of the first week after the treatment, the score of NIHSS of the observation group were lower than that of the control group, with significant different (P < 0.05); the observation group showed reduced volume of brain edemas than that on admission (P < 0.05), whereas the control group the control group showed increased volume of brain edemas than that on admission; the control group displayed increased level of serum AQP4 than that on admission, but without significant difference; the observation group displayed decreased level of serum AQP4 than that on admission (P < 0.05). At the end of the second week after the treatment, the control group showed decreased score of NIHSS than that on admission and at the end of the first week after treatment (P < 0.05). Compared with the control group, the observation group showed a much lower score of NIHSS (P < 0.01), the control group displayed reduced volume of brain edemas than that on admission and at the end of the first week after treatment, but the observation group was even lower than the control group. Both of observation and control groups displayed significantly reduced level of AQP4 (P < 0.05), but the observation group showed a lower AQP4 level than that of the control group (P < 0.05). The therapy of Xingnaojing injection combined with minimally invasive percutaneous drainage could remarkably reduce brain edema, and promote neural functional recovery, thus could be selected as a therapeutic regimen for patients with moderate hypertensive basal ganglia hemorrhage.

高血压基底节区中少量出血早期手术治疗

Objective: To evaluate the efficacy of operative approach via lateral fissure in hypertensive basal ganglia hemorrhage with bleeding volume 20～30ml during early period. Methods: A total of 33 patients with hypertensive basal ganglia hemorrhage underwent microsurgical treatment transsylvian-transinsular approach within 24 hours after stroke. All the patients had definite neurological dysfunction and the blooding volume 20～30ml. The remained hematoma volume after 24 hours, the efficacy after 2 weeks, and activity of Daily Living after 6 months were measured to be compared between the two groups. Results: 24 hours after operation, hematoma was evacuated more than 90% in 27 cases, 70% in 3 cases. 2 weeks after surgical operation, 26 cases got remarkably effect and 5 cases turned better. Follow-up assessment according to the Activity of Daily Living (ADL) for 6 months revealed a good recovery of grade I in 8 cases, grade II in 17,grade III in 5, grade IV in 1. Conclusion: Microsurgical treatment transsylvian-transinsular approach has a significant therapeutic effect on hypertensive basal ganglia hemorrhage of 20～30ml hematoma cases with definite neurological dysfunction.

A clinical analysis on small bone window microsurgical treatment for basal ganglia hypertensive hemorrhage

Objective To investigate the clinical efficacy of small bone window microsurgical treatment for basal ganglia hypertensive hemorrhage.Methods 96 patients with basal ganglia hypertensiv hemorrhage who had undergone small bone window microsurgical treatment for removal of intracranial hematoma within 24 hours after onset during the period of January 2006 to August 2012 were included in this study.Results Cranial CT scans were performed on all the patients 3 and 5 hours after the removal of intracranial hematoma,showing a rate of hematoma removal of 89％.No rebleeding occurred.3 months after the procedure,activities of daily living (ADL) classification revealed grade Ⅰ in 15 patients,grade Ⅱ in 21,grade Ⅲ in 28,grade Ⅳ in 21,and grade Ⅴ in 5; 6 patients were dead.Conclusions Dmall bone window microsurgical treatment is an effective procedure for basal ganglia hypertensive hemorrhage.It is worth further popularizing. Key words: Hypertensive cerebral hemorrhage; Basal ganglia; A small bone window; Microsurgery

The correlation between lateralization of intracerebral hemorrhage in basal ganglia and handedness

To investigate the correlation between lateralization of cerebral basal ganglia hemorrhage and handedness. Medical records and computed tomography (CT) scans for 84 patients with primary hypertensive intracerebral hemorrhage (ICH) in basal ganglia were reviewed. Data of gender, age, handedness, and location of basal ganglia hematoma were statistically analyzed. Data of age, gender, handedness, health condition, and mean blood flow velocity (BFV) in middle cerebral arteries (MCAs) and anterior cerebral arteries (ACAs) on both sides of 114 healthy individuals were statistically analyzed. We found out that the patients with right basal ganglia hemorrhage were mostly left-handed, while patients with left basal ganglia hemorrhage were mostly right handed (p=0.021, r=0.251). And the mean BFV in the right MCAs of left-handed ones are relatively higher, the mean BFV in the left MCAs of right-handers are relatively higher (p=0.008, r=0.248). There 's a correlation between lateralization of cerebral basal ganglia hemorrhage and handedness.

Glioma Mimicking a Hypertensive Intracerebral Hemorrhage

Here, we report a rare case of an anaplastic astrocytoma masquerading as a hypertensive basal ganglia hemorrhage. A 69-year-old woman who had been under medical management for hypertension during the past 3 years suddenly developed right hemiparesis with dysarthria. Brain computed tomography (CT) scans with contrast and CT angiograms revealed an intracerebral hemorrhage (ICH) in the left basal ganglia, without an underlying lesion. She was treated conservatively, but underwent a ventriculoperitoneal shunt operation 3 months after the initial attack due to deteriorated mental status and chronic hydrocephalus. Three months later, her mental status deteriorated further. Magnetic resonance imaging (MRI) with gadolinium demonstrated an irregular enhanced mass in which the previous hemorrhage occurred. The final histological diagnosis which made by stereotactic biopsy was an anaplastic astrocytoma. In the present case, the diagnosis of a high grade glioma was delayed due to tumor bleeding mimicking hypertensive ICH. Thus, a careful review of neuroradiological images including MRI with a suspicion of tumor bleeding is needed even in the patients with past medical history of hypertension.