Observation on the efficacy of parafascicular approach guided by diffusion tensor imaging in the treatment of hypertensive intracerebral hemorrhage
SUN Shengyu
JIA Xiaoxiong
WEN Zi
CHEN Canyu
GAO Maoxiang
WANG Peng
HAO Shaocai
Abstract：Objective To explore the clinical efficacy of minimally invasive surgery using the parafascicular approach guided by Diffusion Tensor Imaging(DTI)in the treatment of hypertensive intracerebral hemorrhage(HICH).Methods The clinical data of 75 patients with HICH were analyzed retrospectively.Among them,45 patients underwent hematoma evacuation via a parafascicular approach beside the white matter fiber tracts using a visualized neuroendoscope,with surgical pathways planned under navigation using DTI image fusion technology(the visualized endoscopic parafascicular approach hematoma evacuation group,referred to as the parafascicular group).The other 30 patients underwent conventional craniotomy for hematoma evacuation under a microscope(the conventional craniotomy hematoma evacuation group,referred to as the conventional group).The surgical time,intraoperative blood loss,hematoma evacuation rate,postoperative recovery time of consciousness,Activity of Daily Living(ADL)score at 6 months postoperatively,and the incidence of postoperative complications were compared between the two groups.Results The surgical time[(2.16±0.73)h vs.(2.98±0.82)h]and intraoperative blood loss[(67.42±35.34)mL vs.(143.33±72.51)mL]in the parafascicular group were both significantly less than those in the conventional group(both P<0.001).The hematoma evacuation rate in the parafascicular group was lower than that in the conventional group,but the difference was not statistically significant(P>0.05).The postoperative recovery time of consciousness in the parafascicular group[(5.69±2.90)d]was shorter than that in the conventional group[(12.10±6.25)d],and the ADL score at 6 months postoperatively[(57.22±21.17)]was higher than that in the conventional group[(48.83±16.27)],with both differences being statistically significant(both P<0.05).The incidence of complications in the parafascicular group was lower than that in the conventional group,but the difference was not statistically significant(P>0.05).Conclusions By utilizing DTI image fusion technology to display the three-dimensional anatomical relationship between the hematoma and white matter fiber tracts,and performing minimally invasive surgery via a fiber tract-parafascicular approach under neuro-navigation guidance with a visualized neuroendoscope,the postoperative recovery time of consciousness in patients with HICH can be shortened,and their postoperative activities of daily living can be improved.
Keywords：intracranial hemorrhagehypertensiveparafascicular approachdiffusion tensor imagingneuronavigation
Publication Date：2025-10-20
Online Publishing Date：2025-12-01(First online date of this platform, not the publication date of the document)
Pages：5( 584-588 )