Comparison of two minimally invasive surgical approaches for hypertensive intracerebral hemorrhage: a study based on postoperative intracranial pressure parameters

Abstract

Abstract Background Increased intracranial pressure (ICP) in patients with hypertensive intracerebral hemorrhage (HICH) has been associated with poor prognosis. The transsylvian insular approach (TIA) and the transcortical (TCA) approach are applied by surgeons for HCIH patients with basal ganglia hematomas of 30–50 ml. The purpose of this study was to compare the postoperative ICP parameters between TIA and TCA to explore which procedure can yield better short-term outcomes in patients with basal ganglia hematoma volumes ranging from 30 to 50 ml. Methods Eighty HICH patients with basal ganglia hematomas 30–50 ml in volume were enrolled in this study. Patients were implanted with ICP probes and divided into the TIA group and the TCA group according to the surgical approach. The ICP was continuously recorded for five days at four-hour intervals. The short-term outcomes were evaluated using the length of hospitalization and postoperative consciousness recovery time. Results No statistically significant differences were found in age, sex, GCS score at admission, hematoma volume, or hematoma clearance rate (p > 0.05). The results showed that the postoperative initial ICP, the ICP on the first postoperative day, the mean ICP, the DICP20 mmHg × 4 h, the postoperative consciousness recovery time, the length of hospitalization, the mannitol utilization rate and the mannitol dosage were lower in the TIA group than in the TCA group (p < 0.05). Postoperative consciousness was positively correlated with the ICP on the first postoperative day, and the length of hospitalization was positively correlated with the mean ICP. Conclusions Compared with TCA, TIA was more effective at improving the short-term outcomes of patients with basal ganglia hematoma (30–50 ml) according to comparisons of postoperative ICP parameters.