There is not clear evidence on the indication and surgical approaches on evacuating basal ganglia hemorrhage caused by hypertensive bleeding. Some studies have shown that minimally invasive approaches have therapeutic potentials, but its benefits remain inconclusive. We describe an endoport assisted endoscopic transsylvian approach for basal ganglia hemorrhage evacuation. We evaluate the safety and efficacy of this approach in a cohort study.
We included 19 patients (mean age 57 years) who underwent the surgery at a single county-level hospital in Yunan Province, China. The majority had a Glasgow coma scale between 9-12 on admission. The midline shift ranged from 16-29mm (mean 19mm). Hematoma volume ranged from 46-106ml (mean 67ml). Six patients (31.6%) presented with intraventricular hemorrhage.
All patients achieved greater than 90% decrease in hematoma volume at post-operative CT scan. The average operative time was 115-minute and average blood loss of 44ml. The most common post-operative complication was pneumonia (63.2%). No rebleeding, seizure, infectious meningitis, or post-operative mortality were observed. A total of 17 patients (89.5%) achieved good functional recovery at follow up within 90 days after surgery (Glasgow outcome scale, GOS 4-5) and 2 patients had severe disability (GOS 3).
Endoport assisted endoscopic surgery through transsylvian approach is safe and effective treatment for hypertensive basal ganglia hemorrhage. The majority of patients have good functional recovery and the rate of severe complications is low.
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