Comparison between transsylvian-transinsular and transcortical-transtemporal approach for evacuation of intracerebral hematoma

Abstract

. Intellectual and scientific content of the study, final approval. ABSTRACT PURPOSE:Hypertensive cerebral hemorrhage in the basal ganglia is a potentially life-threatening cerebrovascular disease with high mortality. Surgical evacuation is an important treatment for intracerebral hemorrhage. However, little is reported about the comparison on the efficacy of various approaches on the prognosis. METHODS:Clinical data of 80 cases of intracerebral hemorrhage which surgically treated via transsylvian-transinsular approach or transcortical-transtemporal approach were collected. The proportion of post-surgery tracheostomy, incidence of digestive tract hemorrhage, revision surgery, the average length of hospital stay, and the six-month efficacy (defined by an ADL score) rate between these two groups were compared. RESULTS:The six-month efficacy rates were 75% and 50% in patients receiving transsylvian-transinsular and transcorticaltranstemporal surgery, respectively (p<0.05). Compared to the transcortical-transtemporal group, the proportion of revision surgery was statistically significantly lower in the transsylvian-transinsular group, (p<0.05). The proportion of post-surgery tracheostomy, the incidence of digestive tract hemorrhage, and the average length of hospital stay were lower in the transsylvian-transinsular group, compared to the transcortical-transtemporal group, but no statistically significant differences were noted in them between the two groups. CONCLUSION:The transsylvian-transinsular approach for evacuation of intracerebral hematoma demonstrates limited complications, shorter length of hospital stay, and improved long-term efficacy and prognosis. These findings suggest this operative approach has potential for wider application.Key words: Intracranial Hemorrhages. Transsylvian-Transinsular Approach. Comparison between transsylvian-transinsular and transcortical-transtemporal approach for evacuation of intracerebral hematoma

Treatment Efficacy of the Transsylvian Approach Versus the Transtemporal Cortex Approach to Evacuate Basal Ganglia Hematoma Under a Microscope

“…In patients who had a good postoperative recovery, we included 7 studies, [19][20][21][22][23][24] [25] with a total of 329 patients in the case group and 330 patients in the control group. There were significant advantages in the transsylvian approach group compared with the transtemporal cortex approach group (OR ¼ 2.248; 95% CI: 1.598-3.160; P ¼ 0.265; I 2 ¼ 21.6) (Fig.…”

Microsurgical Approach to Hypertensive Deep Nuclear Bleed: Preliminary Experience and Short Term Outcome

“…Transcortical approach though is very Figure 1A: Microscopic picture of cortical arachnoid dissection being carried out on sylvian fi ssure with an insulin needle Figure 1B: Dissection being continued parallel to opercular cleft to reach the long gyri of the insula simple and easy to perform, however eloquent area like speech center is always at risk when superior temporal gyrus and middle temporal gyrus are incised. 7,8,13 large hematomas may not be cleared from the transcortical route. Excessive manipulation of brain tissue may lead to second brain damage and edema around it.…”

“…11,14 Transsylvian transinsular (TSTI) approach has been prefered by most of the neurosurgeons as a safe technique for removal of hypertensive ICH. 13,14,15,16,17 Advantages of TSTI over transcortical approach are; small craniotomy, shortest route to reach hematoma cavity, preservation of cortical veins, less brain damage, early and clear control of torn vessel under the microscope, can avoid most of the complications related to decompressive craniectomy. The transsylvian approach is important for exposing the lesions in the insula and basal ganglia including globus pallidus, internal capsule, putamen, external capsule, and claustrum.…”

Hematomas Intracranianos: Aspectos Anatomo-Clínicos

“…As intervenções podem ser conservadoras ou cirúrgicas e serão escolhidas com base no tamanho, localização e acessibilidade do hematoma, levando também em consideração sinais de deterioração neurológica e o risco cirúrgico. Cabe ressaltar que, conforme a metodologia estabelecida, não foi encontrado na literatura um consenso acerca da padronização de indicação de tratamento para cada tipo de hematoma, sendo necessários novos estudos para estabelecimento da conduta mais apropriada (WANG et al, 2013).…”