Effects and prognostic influencing factors of hematoma removal via lateral fissure insular approach in young patients with severe basal ganglia cerebral hemorrhage

WANG Min; HOU Lili; LI Yao; LI Sitong; LI Yunru

Abstract：Objective To investigate the efficacy and prognostic influencing factors of the treatment of severe basal ganglia cerebral hemorrhage (BGCH) in young patients with hematoma removal via lateral cleavage insular approach. Methods A total of 122 young patients with severe BGCH admitted to our hospital from March 2021 to February 2024 were divided into two groups according to random number table method. The control group (n=61) received transtemporal cortex approach to remove hematoma,while the observation group (n=61) received transtemporal lobe approach to remove hematoma. The general data,perioperative indexes (surgery time,intraoperative bleeding volume,hematoma clearance rate,surgery time),incidence of complications and excellent rate of outcome were compared between the two groups. The factors affecting the outcome of young patients with severe BGCH were explored by Multivariate Logistic regression analysis. Results The observation group had shorter surgical time and hospitalization time than the control group,with less intraoperative bleeding and higher hematoma clearance rate (P<0.05). The complications rate of observation group was 4.92％,which was lower than that of the control group 16.40％ (P<0.05). There was no significant difference in excellent and good rate of outcome between the two groups(P>0.05). More blood loss on admission (OR=2.408,95％CI:1.608-3.607),lower GCS score on admission (OR=0.469,95％CI:0.322-0.683),and more postoperative complications (OR=2.275,95％CI:1.525-3.393) and low hematoma clearance (OR=0.401,95％CI:0.265-0.606) were independent risk factors for poor outcome in young patients with severe BGCH (P<0.05). Conclusions There is no significant difference in outcome between the temporal cortex approach and the lateral fusion-insular approach in the treatment of young patients with severe BGCH,but the latter has the advantages of shorter operation time and hospital stay,smaller intraoperative blood loss,higher hematoma clearance rate and fewer complications. The amount of blood loss on admission,the score of GCS on admission,the number of postoperative complications and the clearance rate of hematoma are the influencing factors for the outcome of young patients with severe BGCH.