The Application Effect of Craniotomy through Transsylvian Rolandic Point-Insular Approach on Hypertensive Intracerebral Hemorrhage in Posterior Basal Ganglia.

OBJECTIVE: To evaluate the hematoma clearance and safety of small bone window craniotomy through the lateral fissure Rolandic point-insular lobe approach for patients with hypertensive intracerebral hemorrhage (HICH) in posterior basal ganglia.

METHODS: This retrospective study enrolled a total of 86 patients with HICH in the posterior basal ganglia region who underwent surgery between January 2020 and December 2021. These patients were divided into two groups: the conventional group and the study group. The intraoperative information, postoperative hematoma clearance rate, increasing rate of cerebral edema and rebleeding occurrence rate, postoperative complication rate, and prognoses were compared between the two groups. Additionally, we observed and compared the rate of postoperative cerebral hematoma increase, as well as the neurological function and activities of daily living (ADL) at admission, 3 months, and 6 months after surgery in both groups. Univariate and multivariate logistic regression analyses were performed to explore factors affecting the prognosis of patients with HICH in the posterior basal ganglia region after small bone window craniotomy through the lateral fissure Rolandic point-insular lobe approach.

RESULTS: The study group exhibited significantly shorter automatic eye-opening times and hospital stays compared to the conventional group ( P < 0.05). Furthermore, the study group demonstrated better hematoma clearance rates, lower rates of cerebral hematoma at postoperative 48 h and 72 h, and lower rates of rebleeding compared to the conventional group ( P < 0.05). At 3 and 6 months postsurgery, the study group exhibited a significantly greater improvement in neurological function and ADL compared to the conventional group ( P < 0.05). Additionally, the incidence of postoperative complications in the study group was lower than that in the conventional group ( P < 0.05). Furthermore, the prognosis of the study group was significantly better than that of the conventional group at the 6-month follow-up ( P < 0.05).

CONCLUSION: A small bone window craniotomy via transsylvian Rolandic point-insular approach has been shown to improve the hematoma clearance rate in patients with HICH in the posterior basal ganglia region while also reducing the incidence of complications. This approach is highly safe and feasible for implementation in clinical practice.