title: Effects of transsylvian-transinsular approach to hypertensive putaminal hematoma operation and electroacupuncture on motor recovery.
abstract: OBJECTIVE
  In this study, a comparison of motor recovery on hypertensive putaminal hematoma (HPH) with 30 mL or more has been made between conventional treatment and decompressive craniectomy (DC) combined with electroacupuncture (EA). This study aims to examine whether transsylvian-transinsular approach (TTA) to HPH evacuation, DC, and EA have additional value to post-cerebral hemorrhage motor rehabilitation.
  
  
  METHODS
  One hundred twenty patients with HPH of 30-mL volume or greater, who were admitted within 6 hours after ictus, were included in this study. Of the 120 patients, 80 were operated on for hematoma evacuation DC through TTA. The postoperative patients were divided into combined therapy group (CTG) and operation with exercises group (OEG). Combined therapy group (n = 40) was treated with EA, functional exercises from 1 to 3 days after hematoma evacuation DC through TTA, twice each day, and OEG (n = 40) accepted only the same operation and functional exercises. Another 40 patients were classified as functional exercises group to be treated conservatively and with functional exercises only after their relatives declined authorization for surgery and EA. The habilitation effects were assessed by blinded assessors at weeks 0 and 8. Outcome measures included Fugl-Meyer assessment, Barthel Index, and Functional Independence Measure.
  
  
  RESULTS
  The statistical difference on the motor recovery was considerable (P < 0.05) between CTG and OEG. Significant differences were observed between CTG and physical therapy group (P < 0.01), and we also found statistical difference (P < 0.05) between OEG and functional exercises group. Surgically treated patients received significantly better motor recovery than did the conservatively treated patients.
  
  
  CONCLUSIONS
  Microsurgical treatment via TTA of HPH and postoperative EA at an early stage result in improved outcome of motor recovery. Transsylvian-transinsular approach for HPH operation and postoperative EA at an early stage are advocated.
authors.affiliation: Department of Neurosurgery, Affiliated Ri Zhao People’s Hospital, JiNing Medical College, RiZhao 276826, ShanDong Province, People’s Republic of China. yuhaizhang212@yahoo.com.cn
authors.forename: Yuhai
authors.initials: Y
authors.lastname: Zhang
authors.forename: Wei
authors.initials: W
authors.lastname: Ding
authors.forename: Yunxue
authors.initials: Y
authors.lastname: Yang
authors.forename: Houchi
authors.initials: H
authors.lastname: Xu
authors.forename: Feng
authors.initials: F
authors.lastname: Xiong
authors.forename: Cunzhi
authors.initials: C
authors.lastname: Liu
mesh_terms: D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D019299:Decompression, Surgical; D015671:Electroacupuncture / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D019635:Neurosurgical Procedures / Q000379:methods*; D020146:Putaminal Hemorrhage / Q000601:surgery*; D020127:Recovery of Function; D018709:Statistics, Nonparametric; D016896:Treatment Outcome