A Keyhole Approach Centered by Anterior Squamous Suture to Hypertensive Basal Ganglia Hemorrhage.

OBJECTIVE This study aimed to improve the accuracy and efficacy of the keyhole transsylvian approach to remove hypertensive basal ganglia hemorrhage. The authors presented a stable keyhole craniotomy based on anterior squamous suture to expose insular cortex and basal ganglia. METHODS Twenty-nine patients with hypertensive basal ganglia hemorrhage were treated with keyhole surgery and studied in Guangdong sanjiu brain hospital. RESULTS By using a bone suture marked keyhole transsylvian approach, near-complete (90%) hematoma evacuation was achieved in 21 cases (72.4), 70% to 90% in 8 cases (24.1), and less than 70% in 1 case (3.4%). In our cohort, 55.1% (16/29) with good function (GOS score 4-5), 41.3% (12/29) with disability (GOS score 3), and 3.4% (1/29) in a vegetative state (GOS score 2). No patients died within 6 months of operation. CONCLUSIONS Our method can greatly minimize the bone exposure and precisely located the distal Sylvian fissure. A stable keyhole craniotomy based on bone suture can be identically safe and effective in comparison with classic surgery, and it consumes less time and less intra-operative bleeding.