Chen Chao-Hsuan, Lee Han-Chung, Chuang Hao-Che, Chen Chun-Chung, Lee Wen-Yuan, Huang Ya-I, Chu Yen-Tse, Cho Der-Yang
Department of Neurosurgery, Tainan Municipal An-Nan Hospital-China Medical University Hospital, Tainan, Republic of China.
J Craniofac Surg. 2013 Jul;24(4):1388-92. doi: 10.1097/SCS.0b013e318292c302.
Spontaneous intracerebral hemorrhages account for 20% of all strokes. The Modified Intracerebral Hemorrhage (MICH) score provides a simple, reliable system for decision making regarding surgical treatment. The transsylvian-transinsular approach had previously been neglected because of the dependence on great surgical experience. We believe this approach not only compares favorably with the minimally invasive surgery concept but also preserves most of the cerebral functional cortex with a maximum hematoma evacuation rate.
From May 2007 to September 2008, a single surgeon treated 32 patients with basal ganglia hemorrhage using the transsylvian-transinsular approach. Of these, 20 had MICH scores of 2 to 3; 5 had MICH scores of 4; and 7 had MICH scores of 5. After 24 postoperative hours, we evaluated the hematoma evacuation rate by a computed tomography scan. The functional recovery was evaluated by the Barthel Index at 1, 3, and 6 months postoperatively.
All data were analyzed according to MICH score. The hematoma evacuation rates were in the following order: MICH scores 2 to 3 (97%) > MICH score 4 (92%) > MICH score 5 (90%). Surgery-related mortality was MICH2, 3 (0%) < MICH4 (20%) < MICH5 (43%). The Barthel Index of the MICH2, 3 patients (n = 18) improved from 16.9 at 1 postoperative month to 41.94 at 6 postoperative months.
The transsylvian-transinsular approach for the removal of an ICH was not difficult, and it was found to be a safe method for treating a spontaneous basal ganglion ICH. In addition, this approach conformed with the spirit of minimally invasive surgery.
自发性脑出血占所有中风的20%。改良脑出血（MICH）评分提供了一个简单、可靠的手术治疗决策系统。经外侧裂-经岛叶入路由于依赖丰富的手术经验，此前一直被忽视。我们认为这种入路不仅与微创手术理念相比具有优势，而且能在最大程度清除血肿的同时保留大部分脑功能皮质。
2007年5月至2008年9月，一名外科医生采用经外侧裂-经岛叶入路治疗32例基底节区脑出血患者。其中，20例MICH评分为2至3分；5例MICH评分为4分；7例MICH评分为5分。术后24小时，通过计算机断层扫描评估血肿清除率。术后1、3和6个月通过巴氏指数评估功能恢复情况。
所有数据均根据MICH评分进行分析。血肿清除率依次为：MICH评分2至3分（97%）＞MICH评分4分（92%）＞MICH评分5分（90%）。手术相关死亡率为MICH2、3（0%）＜MICH4（20%）＜MICH5（43%）。MICH2、3患者（n = 18）的巴氏指数从术后1个月的16.9提高到术后6个月的41.94。
经外侧裂-经岛叶入路清除脑出血并不困难，是治疗自发性基底节区脑出血的一种安全方法。此外，这种入路符合微创手术的理念。
