Analysis of the efficacy of minimally invasive surgery for hypertensive cerebral hemorrhage in the basal ganglia region via the transsylvian-insular approach under neuroendoscope and microscope

Liu Zheng; Huang Aiqiang; Yin Jie; Xu Peikun

doi:10.3969/j.issn.1674-3245.2025.04.017

Abstract：Objective To analyze the efficacy of minimally invasive surgery for hypertensive cerebral hemorrhage in the basal ganglia region via the transsylvian-insular approach under neuroendoscope and microscope.Methods A total of 80 patients with basal ganglia hypertensive cerebral hemorrhage who were treated in Suzhou Municipal Hospital affiliated with Anhui Medical University from July 2020 to June 2022 were randomly selected for this study.Using a random number method,the patients were divided into a neuroendoscope group and a microscope group,with 40 patients in each group.Hematoma removal was performed using the transsylvian-insular approach,under neuroendoscopic guidance in one group and microscopic guidance in the other group.Surgical indicators,neurological function,daily living ability,changes in inflammatory markers,clinical efficacy,and incidence of complications were compared between the two groups.Results In the neuroendoscopy group,the surgical wound length,operation duration,hospitalization time,and the proportion of hematoma clearance ≥ 80％were all lower than those in the microscopy group(P＜0.05).At 3 and 6 months post-treatment,the NIHSS scores in the neuroendoscopy group were(10.75±3.04)and(6.76±2.25)respectively,significantly lower than those in the microscopy group,which were(13.90±4.06)and(11.94±3.91)(t=-3.928、-7.262,P＜0.05).At 6 months post-treatment,the Barthel score in the neuroendoscopy group was(61.34±4.19),higher than that in the microscopy group(55.05±5.58),while the FAQ score was(5.11±1.31),lower than that in the microscopy group(6.20±1.66)(t=5.701、-3.260,P＜0.05).At 6-month follow-up,the overall clinical effectiveness did not differ significantly between the two groups(80.00％vs.72.50％).Before treatment,there were no statistically significant differences in IL-6,IL-8,and TNF-α levels between the two groups(P＞0.05).However,at 3 and 7 days post-treatment,these levels were lower in the neuroendoscopy group than in the microscopy group(P＜0.05).The neuroendoscopy group experienced 18 postoperative complications(45.00％),significantly fewer than the 35 complications(87.50％)in the microscopy group(x2=16.157,P＜0.05).Conclusion For patients with the most common basal ganglia hemorrhage undergoing hematoma removal,the overall treatment effects of neuroendoscopy and microscopy are similar.However,minimally invasive surgery under neuroendoscopy offers shorter operative times,causes less trauma to patients,results in better recovery of neurological function and daily living abilities,induces milder postoperative inflammation,and has a lower incidence of complications.Therefore,the neuroendoscopic approach offers greater advantages in clinical practice.