title: Evaluation of invasiveness and efficacy of 2 different keyhole approaches to large basal ganglia hematomas.
abstract: BACKGROUND
  The aim of this study was to evaluate the invasiveness and efficacy of 2 different keyhole approaches to large basal ganglia hematomas (LBGHs).
  
  
  METHODS
  The invasiveness and efficacy of the temporal (15 cases) and the frontal (15 cases) microsurgical keyhole approach were retrospectively evaluated in 30 early-operated patients with LBGH, using recorded neuronavigation data. Invasiveness was assessed calculating the angles of brain retraction and the volume of brain exposed to surgery. Reduced invasiveness was related to a fall of these values. Efficacy was evaluated by comparing the volume of microscopically visualized clot and the largest hemorrhage diameter exposed with the 2 different keyhole approaches. Increased efficacy was related to a rise in these parameters. All estimations were correlated to the volume of residual clot detected on postoperative computed tomography scan.
  
  
  RESULTS
  The comparison between both approaches revealed a significant reduction of invasiveness (smaller angles of brain retraction [P<.001] and reduced brain exposition [P<.001]), as well as a raised efficacy (increased volume of visualized clot [P<.001] and largest hemorrhage diameter exposed to surgery [P<.001]) for frontally approached LBGH. These patients showed less postoperative residual hematomas (P<.05). Residual clots were correlated to the evaluated brain retraction (P<.001) and volume of brain (P<.001), as well as volume of clot surgically exposed (P<.05).
  
  
  CONCLUSIONS
  We conclude that the frontal approach to LBGH leads to less invasiveness and higher efficacy as evaluated by using neuronavigation data. This approach shows a reduced number of patients with residual postoperative clots.
authors.affiliation: Department of Neurosurgery, Städtische Kliniken, Frankfurt am Main Höchst, Akademisches Lehrkrankenhaus der, J-W-Goethe-Universität FFM, 65929 FFM-Höchst, Germany. mcnievas@t-online.de
authors.forename: Mario
authors.initials: M
authors.lastname: Carvi Y Nievas
authors.forename: Selim
authors.initials: S
authors.lastname: Toktamis
authors.forename: Hans-Georg
authors.initials: HG
authors.lastname: Höllerhage
authors.forename: Eberhard
authors.initials: E
authors.lastname: Haas
authors.forename: Albert
authors.initials: A
authors.lastname: Pöllath
mesh_terms: D000328:Adult; D000368:Aged; D020145:Basal Ganglia Hemorrhage / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005625:Frontal Lobe / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods*; D012189:Retrospective Studies; D013702:Temporal Lobe / Q000601:surgery*; D016896:Treatment Outcome