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Transsylvian-Transinsular Approach for Deep-Seated Basal Ganglia Hemorrhage: An Experience at a Single Institution.

Kim SH, Kim JS, Kim HY, Lee SI - J Cerebrovasc Endovasc Neurosurg (2015)

Bottom Line: The average age distribution was similar.The clinical outcome showed correlation with the preoperative neurological symptoms.The TS-TI group was superior to the TC-TT group for evacuation of an intracerebral hematoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

ABSTRACT

Objective: Treatment of spontaneous intracerebral hemorrhage (ICH) remains controversial. However, an extensive hemorrhage with a poor mental status is suitable for surgical evacuation. Our experience with the transsylvian-transinsular (TS-TI) microsurgical approach for deep-seated basal ganglia (BG) ICH was investigated.

Material and methods: A retrospective review was conducted on 86 patients with BG ICH who underwent an operation at the Department of Neurosurgery of our Hospital from September 2011 to October 2014. Thirteen patients underwent craniotomy and the TS-TI microsurgical approach for hematoma evacuation. Twenty-seven patients underwent conventional craniotomy with the trans-cortical transtemporal (TC-TT) approach, and 46 patients underwent a burrhole operation and hematoma drainage using a frameless stereotaxic device (ST).

Results: The average age distribution was similar. The preoperative Glasgow coma scale (GCS) was similar for the TC-TT and TS-TI groups. The pre-operative hematoma levels were higher in the TC-TT (109.4 ± 48.6 mL) and TS-TI (96.0 ± 39.0 mL) groups than in the ST group (46.5 ± 23.5 mL). The hematoma removal rate was 77% in the TC-TT group, 88% in the TS-TI group, and 34% in the ST group. The mean maintenance period of a hematoma catheter was 3.6 days in the ST group. The clinical outcome showed correlation with the preoperative neurological symptoms.

Conclusion: The TS-TI group was superior to the TC-TT group for evacuation of an intracerebral hematoma.

No MeSH data available.


Related in: MedlinePlus

Schematic diagram: To maintain the same surgical conditions, the cortical transsectional area of the transtemporal approach (right) is larger than that of the transsylvian-transinsular approach (left).
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Figure 4: Schematic diagram: To maintain the same surgical conditions, the cortical transsectional area of the transtemporal approach (right) is larger than that of the transsylvian-transinsular approach (left).

Mentions: The TS-TI approach decreased the injury to normal cerebral tissue in the temporal lobe and shortened the distance from the cortex incision to the hematoma. The depth of the sylvian fissure ranges from 20 to 40 mm. The distance from the insular cortex to the hematoma is shorter when using the TS-TI approach compared with that using the direct TC-TT approach. Using the TS-TI approach, the distance is approximately 2 to 15 mm from the hematoma to the insular cortex (Fig. 3).7)11) In addition, the cortical transsectional area is reduced for the same surgical corridor (Fig. 4).


Transsylvian-Transinsular Approach for Deep-Seated Basal Ganglia Hemorrhage: An Experience at a Single Institution.

Kim SH, Kim JS, Kim HY, Lee SI - J Cerebrovasc Endovasc Neurosurg (2015)

Schematic diagram: To maintain the same surgical conditions, the cortical transsectional area of the transtemporal approach (right) is larger than that of the transsylvian-transinsular approach (left).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495086&req=5

Figure 4: Schematic diagram: To maintain the same surgical conditions, the cortical transsectional area of the transtemporal approach (right) is larger than that of the transsylvian-transinsular approach (left).
Mentions: The TS-TI approach decreased the injury to normal cerebral tissue in the temporal lobe and shortened the distance from the cortex incision to the hematoma. The depth of the sylvian fissure ranges from 20 to 40 mm. The distance from the insular cortex to the hematoma is shorter when using the TS-TI approach compared with that using the direct TC-TT approach. Using the TS-TI approach, the distance is approximately 2 to 15 mm from the hematoma to the insular cortex (Fig. 3).7)11) In addition, the cortical transsectional area is reduced for the same surgical corridor (Fig. 4).

Bottom Line: The average age distribution was similar.The clinical outcome showed correlation with the preoperative neurological symptoms.The TS-TI group was superior to the TC-TT group for evacuation of an intracerebral hematoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

ABSTRACT

Objective: Treatment of spontaneous intracerebral hemorrhage (ICH) remains controversial. However, an extensive hemorrhage with a poor mental status is suitable for surgical evacuation. Our experience with the transsylvian-transinsular (TS-TI) microsurgical approach for deep-seated basal ganglia (BG) ICH was investigated.

Material and methods: A retrospective review was conducted on 86 patients with BG ICH who underwent an operation at the Department of Neurosurgery of our Hospital from September 2011 to October 2014. Thirteen patients underwent craniotomy and the TS-TI microsurgical approach for hematoma evacuation. Twenty-seven patients underwent conventional craniotomy with the trans-cortical transtemporal (TC-TT) approach, and 46 patients underwent a burrhole operation and hematoma drainage using a frameless stereotaxic device (ST).

Results: The average age distribution was similar. The preoperative Glasgow coma scale (GCS) was similar for the TC-TT and TS-TI groups. The pre-operative hematoma levels were higher in the TC-TT (109.4 ± 48.6 mL) and TS-TI (96.0 ± 39.0 mL) groups than in the ST group (46.5 ± 23.5 mL). The hematoma removal rate was 77% in the TC-TT group, 88% in the TS-TI group, and 34% in the ST group. The mean maintenance period of a hematoma catheter was 3.6 days in the ST group. The clinical outcome showed correlation with the preoperative neurological symptoms.

Conclusion: The TS-TI group was superior to the TC-TT group for evacuation of an intracerebral hematoma.

No MeSH data available.


Related in: MedlinePlus