Surgical Techniques and Prevention of Complications in the Treatment of Basal Ganglia Hemorrhage Through the Distal Transsylvian Approach

BackgroundThe 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.ObjectiveTo explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage.MethodsFive hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes.ResultsFor the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40–<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551).ConclusionEndoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.

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The concept of “Four Walls, Two Poles” in the lesions of the thalamus and ganglion regions: case report and literature review

BMC Surgery ◽

10.1186/s12893-021-01059-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Haiyang Yang ◽

Gang Bai ◽

Yongli Zhang ◽

Guolong Chen ◽

Lei Duan ◽

...

Keyword(s):

Basal Ganglia ◽

Literature Review ◽

Surgical Resection ◽

Three Dimensional ◽

Surgical Techniques ◽

Surgical Approaches ◽

Surgical Results ◽

Case Presentation ◽

Operation Process ◽

Thalamic Glioma

Abstract Background There are few articles about the surgical techniques of thalamic glioma and the lesions in the basal ganglia area. According to three existing cases and the literature review (Twelve articles were summarized which mainly described the surgical techniques), we discuss the surgical characteristics of lesions of the thalamus and basal ganglia area and summarize the relevant surgical skills. Case presentation Of the three cases, two were thalamic gliomas and one was brain abscess in basal ganglia. According to the three-dimensional concept of the “Four Walls, Two Poles”, lesions of the thalamus and basal ganglia were surgically removed, and the operative effect was analysed by relevant surgical techniques. Surgical resection of the lesions of the thalamus and basal ganglia area according to the three-dimensional concept of the “Four Walls, Two Poles” has achieved good surgical results. Relevant surgical techniques, such as the use of retractors, the use of aspirators, the choice of surgical approaches, and the haemostasis strategy, also played an important role in the operation process. Conclusions In the presented three cases the three-dimensional concept of the “Four Walls, Two Poles” allowed for safe surgical resection of lesions of the thalamus and basal ganglia.

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A minimally invasive anterior skull base approach for evacuation of a basal ganglia hemorrhage

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2015.03.052 ◽

2015 ◽

Vol 22 (11) ◽

pp. 1816-1819 ◽

Cited By ~ 25

Author(s):

Dale Ding ◽

Colin J. Przybylowski ◽

Robert M. Starke ◽

R. Sterling Street ◽

Amber E. Tyree ◽

...

Keyword(s):

Basal Ganglia ◽

Minimally Invasive ◽

Skull Base ◽

Anterior Skull Base ◽

Base Approach ◽

Skull Base Approach ◽

Basal Ganglia Hemorrhage

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Effect of acetylsalicylic acid usage and platelet transfusion on postoperative hemorrhage and activities of daily living in patients with acute intracerebral hemorrhage

Journal of Neurosurgery ◽

10.3171/2012.9.jns112286 ◽

2013 ◽

Vol 118 (1) ◽

pp. 94-103 ◽

Cited By ~ 38

Author(s):

Xiaowei Li ◽

Zhaosheng Sun ◽

Wangmiao Zhao ◽

Jinrong Zhang ◽

Jianchao Chen ◽

...

Keyword(s):

Basal Ganglia ◽

Mortality Rate ◽

Activities Of Daily Living ◽

Acetylsalicylic Acid ◽

Daily Living ◽

Controlled Trial ◽

Postoperative Hemorrhage ◽

Basal Ganglia Hemorrhage ◽

Hemorrhage Volume ◽

Apheresis Platelets

Object The authors evaluated the effects of acetylsalicylic acid (ASA) usage and transfusion of previously frozen apheresis platelets on postoperative hemorrhage, activities of daily living (ADL) score, and mortality rate in patients with acute hypertensive basal ganglia hemorrhage undergoing craniotomy. Methods This was a prospective, double-blind, parallel, randomized controlled trial in patients with acute hypertensive basal ganglia hemorrhage, who had either not received ASA therapy (control) or received ASA therapy. The patients who received ASA therapy were divided according to the results of a platelet aggregation test into ASA-resistant, ASA-semiresponsive, and ASA-sensitive groups. All patients required an emergency craniotomy for hematoma removal after hospitalization. The patients who were sensitive to ASA were randomized to receive one of the following transfusion regimens of previously frozen apheresis platelets: no transfusion, 1 therapeutic dose before surgery, or 2 therapeutic doses (1 before surgery and 1 after 24 hours of hospitalization). The postoperative hemorrhage rate and the average postoperative hemorrhage volume were recorded and the ADL scores and mortality rate were measured during a 6-month follow-up period. Results The rate of postoperative hemorrhage, average postoperative hemorrhage volume, and mortality rate were significantly higher in the ASA-sensitive patients who received ASA therapy compared with patients who did not receive ASA therapy (all p < 0.005). The ADL scores were grouped into different grades and the number of cases in the lower grades was higher and the overall scores were poorer in patients who received ASA therapy compared with those who did not (all p < 0.005). After transfusion of previously frozen apheresis platelets, the postoperative hemorrhage rate, average postoperative hemorrhage volume, and mortality rate of the ASA-sensitive patients were significantly lowered (all p < 0.005), and the ADL scores and their classification level were better than those of patients who did not undergo transfusion (all p < 0.005). Conclusions Transfusion of previously frozen apheresis platelets reduces the rate of postoperative hemorrhage, average postoperative hemorrhage volume, disability rate, and mortality rate in ASA-sensitive patients with acute hypertensive basal ganglia hemorrhage undergoing craniotomy.

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Plasma ADAM-10 levels and functional outcome of acute primary basal ganglia hemorrhage

Clinica Chimica Acta ◽

10.1016/j.cca.2021.11.026 ◽

2021 ◽

Author(s):

Ma-Jing Feng ◽

Wei Wang ◽

Xue-Feng Zhang ◽

Fang-Fang Che ◽

Jie Yang ◽

...

Keyword(s):

Basal Ganglia ◽

Functional Outcome ◽

Basal Ganglia Hemorrhage

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Plasma resistin, associated with single nucleotide polymorphism -420, is correlated with C-reactive protein in Chinese Han patients with spontaneous basal ganglia hemorrhage

Genetics and Molecular Research ◽

10.4238/2012.july.19.4 ◽

2012 ◽

Vol 11 (3) ◽

pp. 1841-1850 ◽

Cited By ~ 3

Author(s):

X.-Q. Dong ◽

Q. Du ◽

W.-H. Yu ◽

Z.-Y. Zhang ◽

Q. Zhu ◽

...

Keyword(s):

Single Nucleotide Polymorphism ◽

Basal Ganglia ◽

Nucleotide Polymorphism ◽

C Reactive Protein ◽

Chinese Han ◽

Single Nucleotide ◽

Reactive Protein ◽

Basal Ganglia Hemorrhage

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Prognostic Value of Circadian Brain Temperature Rhythm in Basal Ganglia Hemorrhage After Surgery

Neurology and Therapy ◽

10.1007/s40120-021-00283-y ◽

2021 ◽

Author(s):

Hsueh-Yi Lu ◽

Abel Po-Hao Huang ◽

Lu-Ting Kuo

Keyword(s):

Basal Ganglia ◽

Prognostic Value ◽

Brain Temperature ◽

Temperature Rhythm ◽

Basal Ganglia Hemorrhage

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Abstract TP20: Prediction of Hemorrhagic Transformation After Endovascular Thrombectomy by Cerebral Blood Volume and Time to Reperfusion

Stroke ◽

10.1161/str.47.suppl_1.tp20 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Tomohide Yoshie ◽

Toshihiro Ueda ◽

Tatsuro Takada ◽

Shinji Nogoshi ◽

Satoshi Takaishi ◽

...

Keyword(s):

Basal Ganglia ◽

Blood Volume ◽

Endovascular Therapy ◽

Cerebral Blood Volume ◽

Hemorrhagic Transformation ◽

Cortical Region ◽

Early Reperfusion ◽

Endovascular Thrombectomy ◽

Significant Difference ◽

Basal Ganglia Hemorrhage

Introduction: Previous studies suggested that low cerebral blood volume (CBV) lesion predicts hemorrhagic transformation after endovascular therapy. Hypothesis: We assessed the hypothesis that delays in time to reperfusion lead to hemorrhagic transformation on T2*-weighted MRI after endovascular therapy in patients with low CBV obtained from pre-treatment CT perfusion (CTP). Methods: We retrospectively analyzed 62 consecutive patients with acute ischemic stroke who were obtained successful reperfusion (TICI 2A-3) by endovascular thrombectomy for internal carotid artery or M1 occlusion. CTP maps were assessed for relative CBV (rCBV) values obtained separately for cortical and basal ganglia regions in the MCA territory. The presence of cortical and basal ganglia hemorrhage (either HI or PH) was assessed on T2*-weighted MRI after endovascular therapy. We analyzed the influence of rCBV in each region, CTP-to-reperfusion time and degree of reperfusion on cortical and basal ganglia hemorrhage. Results: Forty patients developed hemorrhagic transformation. HIs occurred in 16, PH1s in 21, PH2s in 3 and symptomatic hemorrhage in 1 of the patients. rCBV of the cortical region (0.77 versus 0.98, P=0.002) and basal ganglia region (0.64 versus 0.88, P<0.001) were significantly lower in the patients with hemorrhage than in those without. There was no significant difference in CTP-to-reperfusion time between cortical hemorrhage and no cortical hemorrhage groups. However, in the patients with low cortical rCBV (rCBV <0.8) and TICI ≥2b, mean CTP-to-reperfusion time was significantly shorter (70 versus 108 minutes, p=0.021) in the non-cortical hemorrhage group. There was no significant difference in CTP-to-reperfusion time between basal ganglia hemorrhage and non-basal ganglia hemorrhage groups. Conclusions: Early reperfusion decreases risk of cortical hemorrhage in patients with low cortical rCBV. Low rCBV in basal ganglia region is more predictive of basal ganglia hemorrhage than time to reperfusion.

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