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Surgical treatment of hypertensive putaminal hematomas through transsylvian-insular approach

ZHANG Wei1,ZHANG Dong,YANG Li-jun(1 First Hospital of Shijiazhuang City,Shijiazhuang 050011,P.R.China)  
Objective To investigate the clinical effects of hypertensive putaminal hematomas(HPH) through transsylvian-insular approach.Methods Sixty-three patients of HPH with volume of hematomas from 39 to 120 ml average 66 ml were enrolled.All patients have no signs of herniation.There were 23 patients received transcortical surgical treatment and 40 patients received transsylvian-insular approach to remove the hematomas.Results Of the 40 patients who with transsylvian-insular approach,34 patients sobered in postoperative 72 hours,1 sobered in postoperative 14 days,3 lapsed into a persistent coma state and 2 died in postoperative 21 days.Of the 23 patients who received transcortical surgical treatment,13 patients sobered in postoperative 72 hours,4 sobered in postoperative 14 days,5 lapsed into a persistent coma state and 1 died in postoperative 23 days.For the language function of the patients with left hemispheric dominance hematoma,patients with transsylvian-insular approach were better than those who received transcortical surgical treatment.Conclusion Transsylvian-insular approach is a better choice for patients with limited extra-capsular type hematoma by which there will be a better preoperative neurological condition.
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