Clinical Study Of Individualized Minimally Invasive Surgical Treatment Of Hypertensive Basal Ganglia Hemorrhage

Objective: To explore the principle and clinical efficacy of individualized choice ofdifferent minimally invasive surgical treatments on hypertensive basal gangliahemorrhage, as to provide the basic supporting data for the standardization ofindividualized minimally invasive surgical treatment on hypertensive intracerebralhemorrhage.Methods: Totally236patients with hypertensive basal ganglia hemorrhage in mediumvolume(i.e.25-60ml) without cerebral hernia, which were admitted in the department ofneurosurgery, Sichuan Provincial People’s Hospital and Suining Central Hospital, fromJanuary2010to August2013, were enrolled retrospectively. The patients were dividedinto the open microsurgical bone window hematoma evacuation group (group A) with130cases and modified minimally invasive hematoma aspiration and lumen catheterdrainage (group B) with106cases. There were20patients in group A and16patients ingroup B with hematoma ruptured into the ventricle has received ventricular catheterdrainage. There was postoperative rebleeding in7cases of Group A. Four patientsreceived conservative treatment.3cases in microsurgical bone window hematomaevacuation. And postoperative rebleeding occurred in23cases of group B, Thehematomas were dissolved with drainage tube injection of urokinase in13cases.,The left10cases has received microsurgical bone window hematoma evacuation.The prior andpostoperative clinical data of patients were collected and summarized in both groups.Based on several factors affecting the prognosis as clinical classification, hematomacharacteristics (hematoma volume, hematoma shape), the hematoma evacuation rate,postoperative complications (bleeding, infection), the1-month postoperative GOS score and6-month Barthel index score in both group were analyzed comprehensively as toevaluate the efficacy and indications of individualized minimally invasive surgery onhypertensive basal ganglia hemorrhage.Results: The findings showed that the hematoma volume, hematoma shape, clinicalclassification and operation choice play important role in the relation to the prognosis ofthe HBGH patients. The findings are summarized below.1. The impact of hematoma volume and hematoma shape.①For those with hematomavolume between25-40ml, no matter method A or B were used, there were no significantdifference (P>0.05) in the postoperative complications (pulmonary infection, bleeding),1-month postoperative GOS score, and6-month Barthel index score of life.②Hematoma with irregular shape the postoperative complications, the1-monthpostoperative GOS score, and6-month Barthel index score in bone flap approachmicrosurgery was better than the modified minimally invasive hematoma aspiration andlumen catheter drainage group (P<0.05).③To those with the hematoma in40-60ml,regardless of the hematoma shape the average clearance rate of hematoma, postoperativecomplications,1-month postoperative GOS score improvement and6-monthpostoperative Barthel index of life skills in the bone flap approach microsurgery groupwere better than the modified minimally invasive hematoma aspiration and lumencatheter drainage group, and the difference was statistically significant (P<0.05).2. Clinical classification:①For the clinical classification of mild basal gangliahemorrhage there was no significant difference in efficacy and complication after surgeryin two different ways (P>0.05).②And for those in the moderate and severe clinicalclassification, there were lower incidence of postoperative complications, better1-monthpostoperative GOS score improvement and Barthel index in the bone windowmicrosurgical hematoma evacuation group than the aspiration and catheter drainage, thedifference was statistically significant (P<0.05). 3. Surgical approach: The operation time, blood loss and hospital stay of the modifiedminimally invasive hematoma aspiration and lumen catheter drainage group were lessthan that in bone window open microsurgical hematoma evacuation group (P<0.05). Butthe hematoma evacuation rate is lower than that in the hematoma aspiration and lumencatheter drainage group, the difference was statistically significant (P<0.05).4. In groups, the postoperative rebleeding occurred in patients with large and irregularshape hematoma.the modified minimally invasive hematoma aspiration and lumencatheter drainage group in rebleeding rate is higher than that in bone window openmicrosurgical hematoma evacuation group, the difference was statistically significant(P<0.05).If the hematoma volume is greater than the preoperative, the bone windowmicroscopic hematoma removal were performed. And the postoperative pulmonaryinfection increased in the rebleeding patients. And there were1case death in group A and4cases in group B. The death rate is similar between the two groups, without statisticalsignificance (P>0.05).Conclusion: Both methods have their own advantages and disadvantages. Aftercomprehensive analysis of the clinical classification of patients (including patient’s age,state of consciousness, GCS score, bleeding time, whether with or without hydrocephalus,with or without underlying disease), hematoma characteristics (hematoma volume,hematoma location, hematoma shape, whether broken into ventricles or not), anindividualized selection of minimally invasive neurosurgical program can reduce thepatient’s disability and death rate, and improve the quality of life effectively.