title: A new choice of minimally invasive surgery for intracerebral hemorrhage in the striatocapsular regions based on computed tomography scans.
abstract: BACKGROUND
  Currently, minimally invasive surgery is considered as a beneficial treatment of supratentorial spontaneous intracerebral hemorrhage (SICH). A new choice of minimally invasive surgery, translower-Rolandic-point approach (TLRPA) with modified craniotomy, is described in this study. A modified classification of striatocapsular SICH based on the computed tomography scans is also described. The surgical strategy of striatocapsular SICH based on the neuroimaging evaluation is proposed.
  
  
  METHODS
  Clinical data from 60 patients with striatocapsular SICH were used in the study. On the basis of the preoperative computed tomography scans, the hematomas were divided into 4 types and 3 subtypes in the axial slices. The surgical approach was used according to the classification. Effect of surgical treatment was evaluated by Glasgow Outcome Scale score.
  
  
  RESULTS
  The mixed type was the most common (31.7%) and was followed by posteromiddle (21.7%), middle (20.0%), posterolateral (11.7%), posteromedial (8.3%), and anterior (6.6%) types in decreasing order of frequency. The transanterior-Sylvian-point approach was used in 25 patients (41.7%), and TLRPA was used in 35 patients (58.3%). Forty-six patients (76.7%) made a relatively good recovery (Glasgow Outcome Scale scores of 4 and 5), and two (3.3%) were dead.
  
  
  CONCLUSIONS
  The modified classification would help to decide the optimal surgical strategy. The TLRPA with modified craniotomy is a minimally invasive, effective, and safe method to remove the hematoma. The choice of the surgical approach should be tailored for each patient based on preoperative neuroimaging evaluation.
authors.affiliation: From the *Department of Neurosurgery, Ruijin Hospital, and †Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Zhihong
authors.initials: Z
authors.lastname: Zhong
authors.forename: Yuhao
authors.initials: Y
authors.lastname: Sun
authors.forename: Hongyu
authors.initials: H
authors.lastname: Zhou
authors.forename: Qingfang
authors.initials: Q
authors.lastname: Sun
authors.forename: Liuguan
authors.initials: L
authors.lastname: Bian
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000601:surgery*; D003342:Corpus Striatum / Q000000981:diagnostic imaging* / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D015600:Glasgow Coma Scale; D006406:Hematoma / Q000000981:diagnostic imaging; D006801:Humans; D020772:Internal Capsule / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome