经侧裂-岛叶入路和经颞锁孔入路治疗基底节区高血压性脑出血的对比研究OA

Objective To compare the clinical efficacy and safety of microsurgical transsylvian-insular approach versus transtemporal keyhole approach in the treatment of hypertensive intracerebral hemorrhage(HICH)in the basal ganglia region.Methods A retrospective analysis was conducted on clinical data of 90 patients with basal ganglia HICH admitted to Beijing Tongren Hospital Mentougou Campus,Capital Medical University from December 2021 to December 2024.Patients were divided into observation group(transsylvian-insular approach,n=45)and control group(transtemporal keyhole approach,n=45).To compare the perioperative parameters(hematoma clearance rate,operative duration,intraoperative blood loss),preoperative and 2-week postoperative neurological function scores,and incidence of postoperative complications between two groups of patients.Results Statistical analysis revealed that the hematoma evacuation rate in observation group was marginally superior to that in control group,yet the discrepancy between two cohorts did not reach statistical significance(P=0.056);However,the operation time was longer and intraoperative blood loss was significantly higher in observation group(P<0.05).Two weeks following surgical intervention,patients in observation group demonstrated markedly lower National Institute of Health stroke scale scores compared to control cohort(P<0.05),whereas no statistically significant discrepancy was identified in Glasgow coma scale scores between two groups(P>0.05).Regarding safety endpoints,observation group exhibited a lower pulmonary infection rate(2.22%)and overall complication incidence relative to control group,with both comparisons reaching statistical significance(P<0.05).Conclusion The transsylvian-transinsular approach for basal ganglia HICH tends to achieve more complete hematoma evacuation,significantly improves neurological function,but is associated with longer operation time and greater intraoperative blood loss.The transtemporal keyhole approach has advantages of minimal surgical trauma and shorter operation time,making it suitable for patients with poor surgical tolerance.