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Objectives To conduct grading comparison for the damage degree of pyramidal tracts after procedure in patients with unilateral hypertensive putamen hemorrhage via transsylvian-transinsular (TS-TI) approach and transcortical transtemporal (TC-TF) approach using magnetic resonance diffusion tensor imaging (DTI) and to evaluate the postoperative recovery of the patients according to the quality criteria of the activities of daily living (ADL),and to identify the advantages and disadvantages of both surgical approaches.Methods Sixty-three consecutive patients with first onset of unilateral hypertensive basal ganglia putamen hemorrhage admitted to Department of Neumlsurgery in Affiliated Hospital of Southwest Medical University of Traditional Chinese Medicine were enrolled prospectively.The volume of hematoma at admission was 26-45 ml.They were randomly divided into group A and group B by random number table.The patients in group A (n =31) were treated via the TS-TI approach,and those of group B (n =32) were treated via the TC-TT approach.The operator was the same surgeon.The patients of rebleeding were excluded (4 in group A,7 in group B),and 52 patients were actually included,including 27 in group A and 25 in group B.The DTI examinations were perforrned 5 to 8 d after procedure.The image data were processed by PHILIPS Extended MR Workspace 2.6.3.4 (EMW 2.6.3.4) software.The bilateral pyramidal tracts were reconstructed,the damage degree of pyramidal tract and its relationship with hematoma and surgical approach were observe respectively.The ADL quality criteria were used to evaluate the recovery at 3 months after procedure.The SPSS 17.0 software was used to conduct rank sum test for the pyramidal tract injury grade after procedure in both groups.The number of rebleeding in the operation areas and the ADL quality criteria evaluation were tested by Chi-squared test.Results There was no significant difference in the postoperative rebleeding rate between group A (12.9％,4/31) and group B (21.9％,7/32) (x2 =0.367,P =0.545).The postoperative pyramidal tract damage degree of group A was better than that of group B.There was significant difference (U =180.00,P =0.004).The comparison of ADL quality evaluation in both groups after procedure showed that the good prognosis rate (81.5％,22/27) of group A after procedure was better than that of group B (56.0％,14/25).There was significant difference (x2 =3.957,P =0.047).Conclusions The three-dimensional relationship between the hematoma lesions and the pyramidal tracts was observed by DTI,the damage degree of the pyramidal tracts were identified.The TS-TI approach was superior to the TC-TF approach in the postoperative damage degree of pyramidal tract and the quality of ADL for the treatment of hypertensive putamen hemorrhage.
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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 transcortical-transtemporal 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.