Efficacy of different microsurgical techniques via transsylvian-insular approach for basal ganglia hemorrhage
Hu Yongzhen
Liang Jianhao
Qin Yongkai
Zheng Jingjing
Zhang Liyang
Wen Jianping
Jing Yingchao
Li Xuesong
Abstract：Objective To compare the clinical efficacy of the microscope-assisted versus the neuroendoscope-assisted transsylvian-insular approach in the treatment of basal ganglia intracerebral hemorrhage.Methods A total of 204 patients with spontaneous basal ganglia intracerebral hemorrhage were included and randomly divided into a neuroendoscope group(n=96,undergoing neuroendoscope-assisted hematoma evacuation via transsylvian-insular approach)and a microscope group(n=108,undergoing microscopic hematoma evacuation via transsylvian-insular approach)using a random number table.The operative time,hospital stay,hematoma evacuation rate,and incidence of postoperative complications(including intracranial infection,rebleeding,cerebral infarction,epilepsy,gastrointestinal bleeding,and pulmonary infection)were compared between the two groups.Neurological function was assessed using the National Institute of Health Stroke Scale(NIHSS),consciousness state was evaluated using the Glasgow Coma Scale(GCS),and daily living ability was assessed using the Barthel Index.The overall recovery was evaluated using the Glasgow Outcome Scale(GOS)at 6 months postoperatively.Results There were no statistically significant differences in preoperative hematoma volume and time from onset to surgery between the two groups(both P>0.05).The neuroendoscope group had significantly less residual hematoma volume and a higher hematoma evacuation rate than the microscope group(both P<0.05).The operative time and hospital stay were significantly shorter in the neuroendoscope group than in the microscope group(both P<0.05).There was no statistically significant difference in the incidence of postoperative complications between the two groups(P>0.05).At 4 weeks postoperatively,the GCS score was higher and the NIHSS score was lower in the neuroendoscope group than in the microscope group (both P<0.05). At 3 months postoperatively, the Barthel Index was significantly higher in the neuroendoscope group than in the microscope group (P<0.05). There was no statistically significant difference in the good outcome rate based on the GOS score at 6 months postoperatively between the two groups (P>0.05). Conclusions Neuroendoscope-assisted hematoma evacuation via transsylvian-insular approach can more effectively evacuate hematomas, achieve precise hemostasis, reduce postoperative cerebral edema, and improve short-term neurological function and daily living ability in patients. However, it shows no significant advantage over microscope-assisted surgery in improving long-term prognosis at 6 months postoperatively.
Keywords：intracranial hemorrhagehypertensivebasal ganglia regioncraniotomy hematoma removalhematoma removal ratesylvian fissureinsula
Publication Date：2025-09-20
Online Publishing Date：2025-10-17(First online date of this platform, not the publication date of the document)
Pages：6( 505-510 )