title: Transsylvian-transinsular approach for the removal of basal ganglia hemorrhage under a Modified Intracerebral Hemorrhage score.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, Tainan Municipal An-Nan Hospital-China Medical University Hospital, Tainan, Republic of China.
authors.forename: Chao-Hsuan
authors.initials: CH
authors.lastname: Chen
authors.forename: Han-Chung
authors.initials: HC
authors.lastname: Lee
authors.forename: Hao-Che
authors.initials: HC
authors.lastname: Chuang
authors.forename: Chun-Chung
authors.initials: CC
authors.lastname: Chen
authors.forename: Wen-Yuan
authors.initials: WY
authors.lastname: Lee
authors.forename: Ya-I
authors.initials: YI
authors.lastname: Huang
authors.forename: Yen-Tse
authors.initials: YT
authors.lastname: Chu
authors.forename: Der-Yang
authors.initials: DY
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D020145:Basal Ganglia Hemorrhage / Q000473:pathology / Q000601:surgery*; D002423:Cause of Death; D002535:Cerebral Aqueduct / Q000601:surgery; D002540:Cerebral Cortex / Q000601:surgery; D003399:Craniotomy / Q000379:methods; D004210:Dissection / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D006849:Hydrocephalus / Q000145:classification; D006973:Hypertension / Q000517:prevention & control; D019586:Intracranial Hypertension / Q000145:classification; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D012449:Safety; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D000959:Antihypertensive Agents