Comparison The Efficacy Of Keyhole Through Transsylvian-insular Approach And Large Bone Flap Through Temporal-cortex Craniotomy On Treating Hypertensive Basal Ganglia Hemorrhage

Objective: To investigate the clinical efficacy of keyhole through transsylvian-insular approach(KTr)and large bone flap through temporal-cortex approach(LTe)to removing hematoma two methods for treatment on hypertensive in or nearby the basal ganglia(HBGH),and the comparative studies between these groups were made.Methods: Retrospective analysis of 60 clinical datas of these patients with hypertensive basal ganglia hemorrhage(HBGH)and undergone craniotomy evacuation of hematoma admitted to Hebei North University Department of Neurosurgey from December 2015 to June 2017.It is divided into two groups according to the different methods of surgical approach: 30 cases of keyhole through transsylvian-insular approach group(KTr)and 30 cases of large bone flap through temporal-cortex approach(LTe).Comparison the differences of the hematoma clearance rate(HCR),major postoperative complications(MPC)that included cerebral infarction,hydrocephalus,epilepsy,Intracranial infection,gastrointestinal hemorrhage,pulmonary infection,paradoxical herniation(PH),days of hospitalization and the short-term and long-term prognosis between this two groups,then process statistical analysis.Results: ? These two groups of patients with sex,age,history of hypertension,preoperative blood pressure,degree of consciousness disorder(GCS),hematoma volume(HV),middle structure position was no statistically significant difference(P>0.05).? These two groups of patients with hematoma clearance rate is no statistically significant difference(P>0.05).? The major postoperative complications of these two group,the occurrence rate of subscalp effusion and paradoxical herniation(PH)in large bone flap through temporal-cortex approach(LTe)higher than that in keyhole through transsylvian-insular approach(KTr)(P<0.05),there was no significant differenced and statistical meaningless in other complications(P>0.05).? The hospitalization days of keyhole through transsylvian-insular approach(KTr)are significantly less than large bone flap through temporal-cortex approach(LTe)(P<0.05).? Compared between these two groups of patients in GOS one month after surgery and KPS scores six months after surgery,the short-term and long-term prognosis of keyhole through transsylvian-insular approach group(KTr)were superior to large bone flap through temporal-cortex approach(LTe)(P<0.05).Conclusion: ? The keyhole through transsylvian-insular approach group(KTr)was obviously superior to large bone flap throughtemporal-cortex approach(LTe)in surgical treatment of hypertensive basal ganglia hemorrhage(HBGH),and hemostasis was more thorough.At the same time,it is beneficial to the protection of cortical tissue and important blood vessels,reduction of iatrogenic injury.furthermore,KTr conforms more to the concept of minimally invasive surgery.? The keyhole through transsylvian-insular approach(KTr)could avoid the occurrence of subscalp effusion and paradoxical herniation(PH)after operation,promote postoperative rehabilitation and shorten the time of hospitalization.? The keyhole through transsylvian-insular approach(KTr)could significantly improve people's short-term and long-term prognosis and quality of life,and was worth of spreading.