Craniotomy for basal ganglia hemorrhage evacuation

• Hematoma evacuation based on active strategies versus conservative treatment in the management of moderate basal ganglia hemorrhage: A retrospective study
• Management dilemma in a rare case of pituitary apoplexy with akinetic mutism in the setting of ruptured junctional brain aneurysm: A case report and literature review
• Comparison of Craniotomy and Stereotactic Aspiration Plus Thrombolysis in Isolated Capsulo-Ganglionic Hematoma: A Retrospective Analyses
• Retrospective analysis of the surgical management of spontaneous supratentorial intracerebral hemorrhage: A single-center study
• Long-term outcome of stereotactic aspiration, endoscopic evacuation, and open craniotomy for the treatment of spontaneous basal ganglia hemorrhage: a propensity score study of 703 cases
• Minimally Invasive Intracerebral Hematoma Evacuation Using a Novel Cost-Effective Tubular Retractor: Single-Center Experience
• Efficacy and safety of intraoperative ultrasound-assisted neuroendoscopy in the treatment of hypertensive intracerebral hemorrhage via transsylvian approach
• Combined Decompressive Hemicraniectomy and Port-Based Minimally Invasive Parafascicular Surgery for the Treatment of Subcortical Intracerebral Hemorrhage: Case Series, Technical Note, and Review of Literature

A study aimed to improve the accuracy and efficacy of the keyhole transsylvian approach to remove hypertensive basal ganglia hemorrhage. Lin et al. presented a stable keyhole craniotomy based on anterior squamosal suture to expose insular cortex and basal ganglia.

Twenty-nine patients with hypertensive basal ganglia hemorrhage were treated with keyhole surgery and studied in Guangdong sanjiu brain hospital.

By using a bone suture marked keyhole transsylvian approach, near-complete (90%) hematoma evacuation was achieved in 21 cases (72.4), 70% to 90% in 8 cases (24.1), and less than 70% in 1 case (3.4%). In our cohort, 55.1% (16/29) with good function (GOS score 4-5), 41.3% (12/29) with disability (GOS score 3), and 3.4% (1/29) in a vegetative state (GOS score 2). No patients died within 6 months of operation.

This method can greatly minimize the bone exposure and precisely located the distal Sylvian fissure. A stable keyhole craniotomy based on bone suture can be identically safe and effective in comparison with classic surgery, and it consumes less time and less intra-operative bleeding ¹⁾.