title: Transsylvian-Transinsular Approach for Deep-Seated Basal Ganglia Hemorrhage: An Experience at a Single Institution.
abstract: OBJECTIVE
  Treatment of spontaneous intracerebral hemorrhage (ICH) remains controversial. However, an extensive hemorrhage with a poor mental status is suitable for surgical evacuation. Our experience with the transsylvian-transinsular (TS-TI) microsurgical approach for deep-seated basal ganglia (BG) ICH was investigated.
  
  
  METHODS
  A retrospective review was conducted on 86 patients with BG ICH who underwent an operation at the Department of Neurosurgery of our Hospital from September 2011 to October 2014. Thirteen patients underwent craniotomy and the TS-TI microsurgical approach for hematoma evacuation. Twenty-seven patients underwent conventional craniotomy with the trans-cortical transtemporal (TC-TT) approach, and 46 patients underwent a burrhole operation and hematoma drainage using a frameless stereotaxic device (ST).
  
  
  RESULTS
  The average age distribution was similar. The preoperative Glasgow coma scale (GCS) was similar for the TC-TT and TS-TI groups. The pre-operative hematoma levels were higher in the TC-TT (109.4 ± 48.6 mL) and TS-TI (96.0 ± 39.0 mL) groups than in the ST group (46.5 ± 23.5 mL). The hematoma removal rate was 77% in the TC-TT group, 88% in the TS-TI group, and 34% in the ST group. The mean maintenance period of a hematoma catheter was 3.6 days in the ST group. The clinical outcome showed correlation with the preoperative neurological symptoms.
  
  
  CONCLUSIONS
  The TS-TI group was superior to the TC-TT group for evacuation of an intracerebral hematoma.
authors.affiliation: Department of Neurosurgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
authors.forename: Jung Soo
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
authors.forename: Hae Yu
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
authors.forename: Sun-Il
authors.initials: SI
authors.lastname: Lee
keywords: Basal ganglia; Craniotomy; Intracerebral hemorrhage; Transsylvian-transinsular