The main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques.
Stereotactic Catheter Drainage (SCD) surgery is safe and effective in patients with severe hemorrhage and has fewer complications and better clinical outcomes than conventional craniotomy 1).
Endoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL 2).
Endoscopic surgery with the help of a tubular retractor was effective and safe. It allowed for a good visualization of the hematoma and the surrounding brain, and helped in proper hemostasis. The hematoma may also be removed with the help of the microscope and the tubular retractor, in case any difficulty during the endoscopic technique is encountered 3).
Good clinical outcome can be expected after stereotactic catheter drainage in patients with a hematoma volume between 20 and 30 cm3, an initial GCS score ≥ 13, and the absence of internal capsule involvement. Among these patients, stereotactic catheter drainage may have a beneficial effect on early recovery of motor weakness and functional outcome, indicating that lateral-type basal ganglia hematoma compression not involving the internal capsule may be better treated using stereotactic catheter drainage than treated medically 4).
Postoperative rehemorrhage is a severe complication, and it's relative to surgical techniques.
A retrospective survey was conducted on 123 cases of basal-ganglia SICH patients who received surgery from January 2015 to January 2019. Postoperative rehemorrhage within 24 hours was recorded. Preoperative clinical parameters, surgeon experience (<10 years and >20 years), operation time, surgical approach, and hemostasis technique were recorded and analyzed.
The total postoperative rehemorrhage rate was 12.2% (15/123). The univariable analysis showed general surgeons had a higher postoperative rehemorrhage rate than experienced surgeons (30.4% versus 8.6%, P=0.068). The operation time in experienced surgeons was significantly longer (164.9±53.5 versus 137.7±30.8, P=0.016), but they had a higher chance to locate the responsible vessel (74.2% versus 40.0%, p=0.001). Logistic analysis indicated that experienced surgeon significantly reduced the risk of rehemorrhage (odds rate(OR)=0.242, P=0.021). Transsylvian approach was a protective factor for postoperative rehemorrhage (OR=0.291, P=0.045).
Surgeons' experience plays the most important role in postoperative rehemorrhage. Surgeons with rich experience were willing to spend more time to achieve definitive hemostasis in operation. The use of transsylvian approach can significantly reduce rehemorrhage rate. Packing hemostasis with gelatin sponge may increase the complication 5).