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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

(A) Schematic diagram: In the transtemporal approach, the hematoma (circle) is located between the lenticulostriate artery (LA) and M2. (B) Schematic diagram: In the transsylvian-transinsular approach, the M2 branches are initially dissected and retracted. The LA, as a responsible vessel, is located at the anterior route (left).
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Figure 5: (A) Schematic diagram: In the transtemporal approach, the hematoma (circle) is located between the lenticulostriate artery (LA) and M2. (B) Schematic diagram: In the transsylvian-transinsular approach, the M2 branches are initially dissected and retracted. The LA, as a responsible vessel, is located at the anterior route (left).

Mentions: In addition to reducing brain tissue injury, the TS-TI approach has several advantages. First, the M2 branches are initially dissected during the TS-TI approach, which facilitates the localization and treatment of bleeding during surgery. The LA, as a responsible vessel, is located at the anterior route through the transinsular approach. Unlike with the TC-TT approach, the hematoma is located between the LA and M2. The bleeding LA is difficult to control (Fig. 5).12) Second, the incised insular cortex is located at a position lower than that of the hematoma, which results in a more satisfactory hematoma evacuation around deep neurostructures, such as the midbrain, internal capsule, and thalamus. Third, there is no need for navigation systems.


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)

(A) Schematic diagram: In the transtemporal approach, the hematoma (circle) is located between the lenticulostriate artery (LA) and M2. (B) Schematic diagram: In the transsylvian-transinsular approach, the M2 branches are initially dissected and retracted. The LA, as a responsible vessel, is located at the anterior route (left).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: (A) Schematic diagram: In the transtemporal approach, the hematoma (circle) is located between the lenticulostriate artery (LA) and M2. (B) Schematic diagram: In the transsylvian-transinsular approach, the M2 branches are initially dissected and retracted. The LA, as a responsible vessel, is located at the anterior route (left).
Mentions: In addition to reducing brain tissue injury, the TS-TI approach has several advantages. First, the M2 branches are initially dissected during the TS-TI approach, which facilitates the localization and treatment of bleeding during surgery. The LA, as a responsible vessel, is located at the anterior route through the transinsular approach. Unlike with the TC-TT approach, the hematoma is located between the LA and M2. The bleeding LA is difficult to control (Fig. 5).12) Second, the incised insular cortex is located at a position lower than that of the hematoma, which results in a more satisfactory hematoma evacuation around deep neurostructures, such as the midbrain, internal capsule, and thalamus. Third, there is no need for navigation systems.

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