Analysis of the efficacy of transsylvian insular approach and transtemporal cortical approach in the treatment of basal ganglia hemorrhage
Objective To compare the clinical efficacy of transsylvian insular approach and transtemporal cortical approach in the treatment of basal ganglia hemorrhage.Methods The clinical data of 152 patients with basal ganglia hemorrhage who underwent craniotomy in Department of Emergeroy Stroke,the Affiliated Hospital of Jining Medical University from September 2018 to December 2022 were retrospectively analyzed.The patients were divided into transsylvian insular approach group(sylvian approach group,74 cases)and transtemporal cortical approach group(cortical approach group,78 cases)according to different surgical approaches.The operation time,The ratio of bone flap return,hematoma clearance rate,and postoperative rebleeding were compared between the two groups.Three months after operation,the language function of the two groups of patients with left cerebral hemorrhage was compared and analyzed.At 6 months after operation,the modified Rankin scale(mRS)score was used to evaluate the outcomes of the patients.The mRS ≤2 was defined as good outcome,and mRS＞2 was defined as poor outcome.Results The ratio of bone flap return and hematoma clearance rate of the sylvian fissure approach group were 73.0％(54 cases)and(94.3±5.5)％,respectively,which were significantly different from those[50.0％(39 cases)and(86.9±14.1)％]of the cortical approach group(both P＜0.01).There were no significant differences in operation time or rebleeding rate between the two groups(both P＞0.05).At 3-month follow-up,among 34 patients with left basal ganglia hemorrhage in sylvian approach group,the rates of dysarthria and aphasia were 35.3％(12 cases)and 5.9％(2 cases)respectively.Of the 36 patients in the cortical approach group,the rates of dysarthria and aphasia were 44.4％(16 cases)and 30.6％(11 cases)respectively,and the inter-group differences were statistically significant(P=0.004).At 6 months after operation,21.6％(16/74)of the patients in the sylvian approach group had good outcome and 78.4％(58/74)had poor outcome.In the cortical approach group,5.1％(4/78)of the patients had good outcome,94.1％(74/78)of the patients had poor prognosis,and the difference between the two groups was statistically significant(P=0.003).Conclusion Compared with the transtemporal cortex approach,the transsylvian insular approach has less trauma,lower postoperative complications and relatively better outcome in the treatment of basal ganglia hemorrhage.
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