Effect of Different Approaches for Minimally Invasive Drilling and Drainage on Hematoma Clearance Rate in Patients with Hypertensive Basal Ganglia Cerebral Hemorrhage

doi:10.3969/j.issn.1009-0126.2025.11.027

Abstract：Objective To investigate the efficacy of different approaches for minimally invasive drilling and drainage in treating elderly patients with hypertensive basal ganglia cerebral hemorrhage. Methods A retrospective study was conducted on 98 elderly patients with hypertensive basal ganglia cerebral hemorrhage admitted to Jingdezhen Third People's Hospital from February 2019 to February 2024. The patients were divided into two groups based on the surgical approach: the temporal group (53 cases) underwent minimally invasive drilling and drainage through a temporal approach, while the frontal group (45 cases) underwent the same procedure through a frontal approach. Perioperative indicators, complication incidence, plasma renin activity (PRA), angiotensin II (Ang II), and short-term prognosis were compared between the two groups. Results There were no statistically significant differences between the two groups in terms of operation time, hematoma clearance rate at 7 days post-operation, hospitalization duration, or total complication rate (P > 0.05). However, the hematoma clearance rate at 3 days post-operation was significantly higher in the frontal group than in the temporal group [(46.51±2.24)% vs (42.21±2.61)%, P < 0.01]. Compared with pre-operation, both groups showed a significant decrease in PRA [(3.16±0.58) μg/(L·h) vs (4.28±0.93) μg/(L·h), (2.35±0.47) μg/(L·h) vs (4.36±0.98) μg/(L·h)] and Ang II [(67.44±10.46) ng/L vs (93.79±12.48) ng/L, (58.95±13.39) ng/L vs (95.08±13.26) ng/L] levels post-operation, with statistical significance (P < 0.05). At 3 days post-operation, the PRA [(2.35±0.47) μg/(L·h) vs (3.16±0.58) μg/(L·h)] and Ang II [(58.95±13.39) ng/L vs (67.44±10.46) ng/L] levels in the frontal group were significantly lower than those in the temporal group, with statistical significance (P < 0.01). There was no statistically significant difference in prognosis at 90 days post-operation between the two groups (P > 0.05). Conclusion Both the frontal and temporal approaches can meet the requirements of minimally invasive drilling and drainage. The complication rates are similar, and the prognosis is good in both groups. However, the frontal approach has a higher early hematoma clearance efficiency, effectively reduces PRA and Ang II levels, and offers greater advantages in improving postoperative neurological function and daily living abilities.