Early Microsurgical Treatment Of Hypertensive Putaminal Hemorrhage Through Transsylvian Fissure

Objective: To analyse the outcome and prognosis of hypertensive basal ganglia hemorrhage patients who underwent early microsurgical transsylvian approach .Methods: 36 patients who were admitted in our hospital from October 2006 to July 2008 because of hypertensive basal ganglia hemorrhage were retrospectively analysed. The inclusion criterias are GCS 6-9 operated within 10 hours of ictus ,age between 35-75 year. Patients were divided into 2 groups. 17 patients who underwent transsylvian mircosurgical approach were grouped as A. 19 patients who underwent transcortical approach were grouped as B. Operation method:For the Group A patients, pterion craniotomy was performed and bone window extended for 3 cm in diameter, the sylvian fissure was drawn off gently and access made to the hematoma cavity through insula. For the transcortical approach horse shoe incision was given over temporal region ,craniotomy extended for 7cm×8cm, then middle temporal gyrus was resected and hematoma cavity entered. 6 month postoperatively,statistical analysis was performed regarding the mortality rate ,GOS score and ADL score.Result-In the microsurgical transsylvian approach group, out of 17 patients, 3 patient died ,6 month postoperatively ADL scores are as follows: gradeⅡ,Ⅲ,Ⅳ, andⅤhave respectively 3, 8, 3,and 3 patients:6 month postoperative GOS scoring are as follows:three patients have score 1,eleven patients have score 3, and three patients have score 4. In the transcortical craniotomy group out of 19 patients,7 patients died,6 month postoperative ADL scores are as follows: gradeⅢandⅤhave respectively 12 and 7 patients:6 month postoperative GOS scoring are as follows:seven patients have score 1, twelve patients have score 3.Conclusion-Mortality rate of transsylvian microsurgical approach group is 17.65% and mortality rate of transcortical approach group is 36.84% but the differences are not statistically significant between the two groups(P>0.05). Average GOS score of transsylvian microsurgical approach group and transcortical approach group 6 month postoperatively are 2.82 and 2.26 respectively but the differences are not statistically significant between the two groups(P>0.05). Average ADL score of transsylvian microsurgical approach group and transcortical approach group 6 month postoperatively are 3.35 and 3.74 respectively but the differences are not statistically significant between the two groups(P>0.05). Between the two groups , the result shows there is no statitically significance. For patients with small volume of hematoma and without brain herniation ,the use of transsylvian approach provides less trauma to the brain.