Distal transsylvian-traninsular approach for the putaminal hypertensive hemorrhages: surgical experience and technical note.

ABSTRACT

BACKGROUND: Up to now, no systemic studies about the surgical approaches and microsurgical techniques of distal transsylvian-transinsular approach to putaminal hypertensive intracranial hemorrhages (PHHs) were reported. METHODS: A retrospective analysis was performed on 68 consecutive patients with PHH who underwent surgical treatment at the Department of the affiliated Bayi Brain Hospital, the Military General Hospital of Beijing PLA, from May 2009 to December 2011. RESULTS: By using transsylvian-transinsular approach, near-complete (>90%) evacuation was achieved in 51 cases (75%). Glasgow Coma Scale scores were significantly improved at discharge compared with admission scores (P < 0.001). The overall survival rate at 6 months was 95.6% (65/68), including 60.3% (41/68) with good function (Glasgow Outcome Scale [GOS] score, 4-5), 19.1% (13/68) with disability (GOS score, 3), and 16.2% (11/68) in a vegetative state (GOS score, 2). The mortality rate (GOS score, 1) was 4.4% (3/68). CONCLUSIONS: Transsylvian-transinsular approach is effective and minimally invasive for PHH. The opening of sylvian fissure toward the pars opercularis behind the level of anterior ascending rami could provide a more suitable angle to hematoma and the ability to treat the responsible vessels.