A New Choice of Minimally Invasive Surgery for Intracerebral Hemorrhage in the Striatocapsular Regions Based on Computed Tomography Scans

作者：Zhong, Zhihong; Sun, Yuhao; Zhou, Hongyu; Sun, Qingfang; Bian, Liuguan^*

来源：Journal of Craniofacial Surgery, 2014, 25(4): 1195-1199.

DOI：10.1097/SCS.0000000000000839

• Spontaneous intracerebral hemorrhage
• striatocapsular region
• minimally invasive surgery
• transanterior-Sylvian-point approach
• translower-Rolandic-point approach

Background: Currently, minimally invasive surgery is considered as a beneficial treatment of supratentorial spontaneous intracerebral hemorrhage (SICH). A new choice of minimally invasive surgery, translower-Rolandic-point approach (TLRPA) with modified craniotomy, is described in this study. A modified classification of striatocapsular SICH based on the computed tomography scans is also described. The surgical strategy of striatocapsular SICH based on the neuroimaging evaluation is proposed.
Methods: Clinical data from 60 patients with striatocapsular SICH were used in the study. On the basis of the preoperative computed tomography scans, the hematomas were divided into 4 types and 3 subtypes in the axial slices. The surgical approach was used according to the classification. Effect of surgical treatment was evaluated by Glasgow Outcome Scale score.
Results: The mixed type was the most common (31.7%) and was followed by posteromiddle (21.7%), middle (20.0%), posterolateral (11.7%), posteromedial (8.3%), and anterior (6.6%) types in decreasing order of frequency. The transanterior-Sylvian-point approach was used in 25 patients (41.7%), and TLRPA was used in 35 patients (58.3%). Forty-six patients (76.7%) made a relatively good recovery (Glasgow Outcome Scale scores of 4 and 5), and two (3.3%) were dead.
Conclusions: The modified classification would help to decide the optimal surgical strategy. The TLRPA with modified craniotomy is a minimally invasive, effective, and safe method to remove the hematoma. The choice of the surgical approach should be tailored for each patient based on preoperative neuroimaging evaluation.

• 出版日期2014-7
• 单位上海市闵行区中心医院; 上海交通大学