Comparison between surgical outcomes of the minipterional and pterional approaches in hypertensive intracerebral hemorrhage patients

Comparison between surgical outcomes of the minipterional and pterional approaches in hypertensive intracerebral hemorrhage patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison between surgical outcomes of the minipterional and pterional approaches in hypertensive intracerebral hemorrhage patients Ittipon Gunnarut, Kritsada Buakate This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5862890/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Intracerebral hemorrhage is a condition which entails high rates of morbidity and mortality. Effective interventions range from conservative treatment to surgical management. The minipterional approach is an alternative, minimally invasive method used to treat various lesions. This report aims to compare the clinical outcomes and length of hospital stay resulting from the minipterional and pterional approaches in basal ganglion hemorrhage. Results Demographic Data: The age of patients who underwent the pterional approach was significantly higher than that of the minipterional group. Clinical Outcomes: The minipterional group had better postoperative Glasgow Coma Scores and shorter length of hospital stay than their counterparts in the conventional group. Conclusion The minipterional approach is an effective alternative for treating hypertensive basal ganglion hemorrhage, yielding shorter hospital stays and better outcomes. Minipterional Pterional Basal ganglion hemorrhage Glasgow Coma Score Figures Figure 1 Figure 2 Figure 3 Background Cerebrovascular disease is expected to remain a pervasive issue in the future, presenting significant challenges with its high rates of morbidity and mortality. Intracerebral hemorrhage is of particular concern due to its severe mortality rates; in Thailand, the morbidity and mortality rates are very high, at about 27 percent ( 1 ) . Effective interventions range from blood pressure control and surgical management, including craniotomy or craniectomy with hematoma removal, to endoscopic procedures and mini-craniectomy/craniotomy techniques ( 2 ) . Traditionally, the pterional approach has been widely employed in neurosurgery for hypertensive intracerebral hemorrhage, particularly in cases involving the basal ganglia, a common site for hypertensive hemorrhages. Recently, the endoscopic transcranial approach with hematoma removal has been widely used for intracerebral hemorrhage; however, the cost of this modality is very high. The minipterional approach, a refined modification and alternative technique for basal ganglion hemorrhage, has been adopted by numerous neurosurgeons, highlighting some potential benefits over the conventional technique. Lin, Bon-Jour et al. reported good outcomes and hematoma evacuations, but only four patients were included in their study. Another report by the same authors indicated that minipterional craniotomy with a rostral transylvian-transinsular approach is a feasible and effective strategy for managing symptomatic hypertensive basal ganglion hemorrhage. This minimally-invasive surgery provides a high rate of functional independence and is strongly recommended for suitable candidates ( 3 , 4 ) . Objectives This publication aims to compare the clinical outcomes and length of hospital stay resulting from the minipterional and pterional approaches in hypertensive intracerebral hemorrhage, with a particular focus on basal ganglion hemorrhages. Despite numerous publications on the pterional approach for basal ganglion hemorrhage evacuation, there remains a lack of direct comparative studies evaluating the minipterional approach and its potential advantages or disadvantages. Surgical technique The patient's head is turned to the contralateral side at a 30–45 degree angle with shoulder elevation, as shown in Picture 1. The frontotemporal incision is then made in the standard fashion; however, in the minipterional approach, the incision is shorter, as shown in Fig. 2 . The scalp is elevated, and the muscle is cut and elevated. Frontotemporal craniectomy is performed, but mini-craniectomy (estimated 3–4 cm) is done in the minipterional approach. The dura is opened, and the sylvian fissure is dissected. Cerebrospinal fluid (CSF) is released, and the fissure is dissected using the inside-out technique to expose the insular cortex. Normally, the distal sylvian fissure is only split, and a corticotomy is made in the insular cortex. The hematoma is then removed, and the bleeding point is identified and coagulated. A retractor-less technique is used during hematoma removal. Finally, the dura and the scalp are closed. Statistical analysis Statistical analysis was performed using SPSS software version 22.0 (SPSS Inc., Chicago, Illinois, USA). The Shapiro–Wilk test was performed to evaluate the normality of the distribution of the data. Continuous data were presented as mean ± standard deviations (SD) or median (min-max), while categorical data were presented as number (percent). The student’s t test was used to compare the continuous data (for normally distributed data) and Mann–Whitney tests was utilized for non-normally distributed data. Chi-squared was used to compare the categorical data between two groups, and Spearman's rank correlation coefficient (r s ) was employed to evaluate the magnitude and orientation of the association between two variables. A p value of ≤ 0.05 was regarded as statistically significant. Results The total number of patients screened for the study was 27, 12 of whom underwent the pterional approach and 15 of whom received the minipterional alternative. Table 1 shows a comparison of patient characteristics of those who underwent the minipterional and pterional approaches. The data indicates that there was a significant difference between the ages of the two groups; patients who underwent the pterional approach were older than those who underwent the minipterional approach. In contrast, the other characteristics did not show any statistically significant difference. Table 1 Comparison between characteristics and clinical outcomes of the pterional and minipterional approaches Characteristic Pterional approach (n = 12) Minipterional approach (n = 15) p value Sex 1.000 B Male 9 (75.0) 11 (73.3) Female 3 (25.0) 4 (26.7) Comorbidity 8 (66.7) 11 (73.3) 1.000 B Age (year) 56.3 ± 8.3 48.5 ± 10.5 0.049* A Antibiotic preoperatively 9 (75.0) 12 (80.0) 1.000 B Blood preoperatively (cc) 57.0 (32.0-160.7) 40.3 (27.1–98.6) 0.205 C GCS preoperatively 8.2 ± 3.4 8.5 ± 3.3 0.820 A Values represented as mean ± SD, n (%) and median (min-max), * = significant at p value ≤ 0.05 A = The p value by Student's t-test B = The p value by Chi-squared test C = The p value by Mann-Whitney U test Table 1 compares the patient characteristics of those who underwent the minipterional and pterional approaches. The data indicates that the ages of patients in the two groups differed significantly: those who underwent the pterional approach were older than those who received the minipterional approach. However, the other characteristics did not show any statistically significant difference. Table 2 Comparison between outcomes of the pterional and mini pterional approaches. Outcomes Pterional approach (n = 12) Minipterional approach (n = 15) P value Blood post operative (cc) 2.6 (0.0-29.9) 5.5 (0.0-33.2) 0.765 C GCS Post operative (average) 10.0 (3.0–15.0) 12.0(10.0–15.0) 0.018* C GCS increase 1.0 (6.0–9.0) 4.0 (2.0–10.0) 0.053 C Hospital Stay (days) 41.0 (5.0-120.0) 28.0 (3.0–90.0) 0.434 C Death 2 (16.7) 1 (6.7) 0.569 B Values represented as n (%) and median (min-max), * = significant at p value ≤ 0.05 B = The p value by Chi-squared test C = The p value by Mann-Whitney U test Table 2 shows that the post-operative Glasgow Coma Score (GCS) after the minipterional approach was better than after the pterional approach (P value 0.018). The GCS was higher in patients who underwent the minipterional approach, but this increase was not statistically significant. In terms of hospital stay, the minipterional approach group had a shorter duration compared to the pterional approach group, while the pterional group had lower residual hematoma than the minipterional group, but these differences were not statistically significant. Table 3 Factors associated with outcomes. Factors Blood post operatively GCS post operatively Hospital stay Sex Male 5.3 (0.0-33.2) 11.0 (1.0–15.0) 29.0 (3.0-120.0) Female 5.3 (0.0-18.1) 11.0 (10.0–15.0) 28.0 (5.0–90.0) P value 0.685 C 0.416 C 0.824 C Comorbidity 5.5 (0.0-33.2) 11.0 (1.0–15.0) 28.0 (5.0–90.0) P value 0.341 C 0.394 C 0.814 C Antibiotic preoperatively 4.7 (0.0-33.2) 11.0 (1.0–15.0) 78.2 (79.4-361-3) P value 0.067 C 0.859 C 0.208 C Age (years) (r s ) 0.120 0.220 0.026 P value 0.552 D 0.271 D 0.898 D Blood preoperatively (r s ) 0.038 0.313 0.009 P value 0.851 D 0.112 D 0.964 D GCS Preoperatively (r s ) 0.047 0.383 0.130 P value 0.815 D 0.049 D 0.517 D Values are represented as median (min-max) and Spearman's rank correlation coefficient (r s ), * = significant at p value ≤ 0.05 C = The p value by Mann-Whitney U test D = The p value by Spearman's rank correlation coefficient (r s ) Table 3 shows no association between residual hematoma, post-operative Glasgow Coma Score (GCS), hospital stay, and variables such as sex, comorbidity, preoperative antibiotic use, age, preoperative hematoma volume, and preoperative GCS. Discussion Hypertensive intracerebral hemorrhage is a condition which entails high rates of morbidity and mortality ( 5 ) . The basal ganglion is the most common location for hemorrhage, and surgical evacuation remains a controversial topic. The benefits of surgical management include a rapid decrease in intracranial pressure and a reduction in brain edema caused by the hematologic reaction. The transylvian approach is one of the best choices for hematologic evacuation, with literature reviews indicating that this approach is better than transcortical resection because it achieves minimal cortex injury and brain edema ( 6 ) ; however, there have been few comparisons between the minipterional and standard pterional approaches in the context of transylvian evacuation. 1. Hematoma Removal The transylvian approach is effective for basal ganglion hematoma evacuation because the bleeding point is directly visible, but it is challenging to remove the entire hematoma volume, especially in higher locations such as the parietal region. In this study, the hematoma evacuation volumes were 5.5 and 2.6 CC in the minipterional and conventional pterional approaches, respectively; this difference was not statistically significant. The percentage of hematoma clearance in this study was comparable to rates reported in other studies. The transylvian-transinsular approach has shown significant improvement in hematoma clearance rates, with past studies reporting over 90% clearance in many cases (Wang et al., 2023; Zhu et al., 2012) ( 7 , 8 ) . Other journals have reported an average clearance from the minipterional approach of around 89.5-94.32% (3,4) . In this study, the clearance rates were about 86.3% and 95.4% in the minipterional and conventional pterional approaches, respectively, showing no significant difference from those found in other studies. 2. Clinical Outcomes The recovery time for the minipterional approach is theoretically shorter due to the minimal tissue dissection required. This report compared the minipterional and pterional approaches and showed that the hospital stay after the minipterional approach was shorter than after the conventional pterional approach (28 and 41 days, respectively). Post-operative GCS was significantly better following the minipterional approach. This is probably because of the minimal tissue dissection and trauma involved in with the minipterional approach, and it aligns with Lin's findings ( 3 ) . Among other studies, such as those on the transylvian approach, one report found that hospital stays averaged 17.38 days ( 8 ) , while Minxue Lian reported 18 days for the transylvian group ( 9 ) . In this study, hospital stay in both groups was longer than recorded in other studies, probably because of caregiver challenges in home care. 3. Comparison of Transylvian and Transcortical Approaches Open surgery's role in managing spontaneous intracerebral hemorrhage remains vague ( 10 – 12 ) . However, early removal of basal ganglion hemorrhage is associated with alleviation of neurological insult and improvement in functional outcomes ( 10 ) . Some reports comparing transcortical and transylvian approaches indicate better recovery outcomes and shorter hospital stays after the transylvian approach ( 13 – 16 ) . Wang X reported longer hospital stays for the transcortical approach (average 42 days) than after the transylvian alternative (35 days) ( 16 ) . This study's hospital stays for the minipterional approach were shorter than those recorded in Wang’s research; this was probably due to the minimal surgical manipulation used in the minipterional transylvian approach. 4. Comparison of minipterional and punctured drainage basal ganglion hemorrhage procedures The punctured drainage basal ganglion hemorrhage technique is an alternative procedure for patients with hypertensive basal ganglia hemorrhage, and some reports have shown show that this intervention is effective in treating these patients ( 17 ) . The volume of the hematoma after treatment has been found to be significantly lower in patients undergoing the drainage technique than in those receiving the traditional treatment; furthermore, the duration of hospitalization was significantly shorter in drainage patients than in their counterparts receiving the traditional intervention. Compared with the minipterional approach in this report, the residual hematoma of the minipterional group was lower than in the drainage group ( 17 – 18 ) ; however. hospital stay was longer in the minipterional group. 5. Comparison between the outcomes of the minipterional and endoscopic approaches in basal ganglion hemorrhage After the endoscopic approach, average residual hematoma has been reported at about 1.2-6.375 cc ( 19 – 21 ) , while hospital stay averaged about 17 days ( 19 ) . Following the minipterional approach in this report, the residual hematoma was within the range reported in the other journals, but the hospital stay was longer than after the endoscopic approach. Conclusion The minipterional approach is an alternative modality for removal of basal ganglion hemorrhage, yielding shorter hospital stays than the conventional approach together with good outcomes. Future research should include prospective randomized controlled trials comparing the minipterional with the pterional approach or other minimally invasive approaches, such as endoscopic or puncture approaches. Abbreviations CSF Cerebrospinal fluid GCS Glasgow Coma Score Declarations Acknowledgements None. Authors’ contribution TG has given substantial contributions to the conception and the design of the manuscript, including analysis and interpretation of data. All authors have participated in drafting the manuscript. TG revised it critically, and all authors read and approve the final version. Funding Self-funding by authors. Availability of data and materials The data supporting the results of this article are included within the article. Ethics approval and consent to participate The study protocol was approved by the Ethics Committee of Rajavithi Hospital (No. 190/2024). The authors certify that they have obtained all appropriate consent forms, in which patients gave their permission for their images and other clinical information to be reported in the journal. They were clearly informed that although neither their names nor initials would be published, and all due efforts would be made to conceal their identity, anonymity could not be guaranteed. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. References Kongbunkiat K, Kasemsap N, Thepsuthammarat K, Tiamkao S, Sawanyawisuth K. National data on stroke outcomes in Thailand. J Clin Neurosci. 2015;22(3):493–7. Kandasamy R, Idris Z, Abdullah JM. Surgery of intracerebral hemorrhage. Neurovascular Surgery [Internet]. 2019 [cited 2024 Dec 1]; 1:201 – 10. Available from: https://link.springer.com/chapter/ 10.1007/978-981-10-8950-3_24 Bon-Jour L, Yi-An C, Tzu-Tsao C, Wei-Hsiu L, Chi-Tun T, Dueng-Yuan H, et al. Clinical Efficacy of Minipterional Craniotomy with Rostral Transsylvian-Transinsular Approach for Hypertensive Basal Ganglion Hemorrhage. J Med Sci. 2020;40(4):175–80. Bon-Jour L, Yi-An C, Tzu-Tsao C, Wei-Hsiu L, Chi-Tun T, Dueng-Yuan H, et al. Minipterional Craniotomy with Transsylvian-transinsular Approach for Hypertensive Putaminal HemorrhageA Preliminary Report. J Med Sci. 2017;37(2):56–60. Varshney R, Singh BK, Choudhary A. surgical Management of large Basal Ganglia Hemorrhage: A Bi-institutional Experience. Iran J Neurosurg. 2024;10:1–11. Xu T, Liu H, Peng L, Li H, Wang J, Jiang Y, et al. Treatment Efficacy of the Transylvian Approach Versus the Transtemporal Cortex Approach to Evacuate Basal Ganglia Hematoma Under a Microscope. J Craniofac Surg. 2016;27(2):308–12. 7, Wang G, Chen X, Meng L, Liu Y, Dai Y, Wang W. The Application Effect of Craniotomy through Transylvian Rolandic Point-Insular Approach on Hypertensive Intracerebral Hemorrhage in Posterior Basal Ganglia. Behav Neurol. 2023;2023:2266691. Kim SH, Kim JS, Kim HY, Lee S. Transylvian-Transinsular Approach for Deep-Seated Basal Ganglia Hemorrhage: An Experience at a Single Institution. J Cerebrovasc Endovasc Neurosurg. 2015;17(2):85–92. Lian M, Li X, Wang Y, Che H, Yan Z. Comparison of two minimally invasive surgical approaches for hypertensive intracerebral hemorrhage: a study based on postoperative intracranial pressure parameters. BMC Surg. 2024;24:10. Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral hematomas in the International Surgical Trial in Intracerebral Hemorrhage (STICH): A randomised trial. Lancet. 2005;365:387–97. Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral hematomas (STICH II): A randomised trial. Lancet. 2013;382:397–408. Hemphill JC, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M et al. Guidelines for the management of spontaneous intracerebral hemorrhage: A guideline for healthcare professionals from the American Heart Association/American Stroke Association Stroke. 2015;46:2032–60. Rincon F, Mayer SA. Intracerebral hemorrhage: getting ready for effective treatments. Curr Opin Neurol. 2010;23:59–64. Zheng JS, Yang F, Xu QS, Yu JB, Tang LL. Treatment of hypertensive intracerebral hemorrhage through keyhole Transylvian approach. J Craniofac Surg. 2010;21(4):1210–2. Wang X, Liang H, Xu M, Shen G, Xu L. Comparison between Transylvian-transinsular and transcortical-transtemporal approach for evacuation of intracerebral hematoma. Acta Cir Bras. 2013;28:112–8. Xu T, Liu H, Peng L, Li H, Wang J, Jiang Y, et al. Treatment efficacy of the Transylvian approach versus the transtemporal cortex approach to evacuate basal ganglia hematoma under a microscope. J Craniofac Surg. 2016;27:308–12. Wang L, Tang Y, Shi Y, Fan YW, Wu HM, Li X. Clinical Study on a Modified Hematoma Puncture Drainage Treatment in Patients with Hypertensive Basal Ganglia Hemorrhage. World Neurosurg. 2022;164:e300–6. Yuan Z, Wei Q, Chen Z, Xing H, Zhang T, Li Z. Laser navigation combined with XperCT technology-assisted puncture of basal ganglia intracerebral hemorrhage. Neurosurg Rev. 2023;46(1):104. Ali M, Zhang X, Ascanio LC, Troiani Z, Smith C, Dangayach NS, et al. Long-term functional independence after minimally invasive endoscopic intracerebral hemorrhage evacuation. J Neurosurg. 2022;138(1):154–64. Wu X, Liu H, Zhang R, Du Y, Cai Y, Tan Z. Prognostic significance of perihematomal edema in basal ganglia hemorrhage after minimally invasive endoscopic evacuation. J Neurosurg. 2023;139(6):1784–91. Lee CC, Huang APH, Chen CC, Liu ZH, Yeap MC, Chen KT. Minimally invasive endoscopic evacuation with the novel, portable Axonpen neuroendoscopic system for spontaneous intracerebral hemorrhage Author links open overlay panel. J Clin Neurosci 2024:119:93–101. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5862890","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":408985920,"identity":"9fd0b589-6d15-4667-893e-dc2272aacb56","order_by":0,"name":"Ittipon Gunnarut","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYBACNjiLvQFIGFiQoIWH5wBIiwQJ1vFIJIAoIrTw8a8xe1xQcy9xv+Tzqxt+FEgw8Ld3J+B3mMQbc+MZx4oTe6Rzym72AB0mcebsBgJazphJ87AlgLSk3eABajGQyCVGyz+gFskzaTf/EKWFv8dMmrcNqEWC/dhtIm1hK5Pm7Usw7jmTw3ZbxkCCh6Bf5PsPb5Pm+ZYg295+/NnNN39s5Pjbe/FrYYBEBwjwGIBJ/MpBgP8AjMX+gLDqUTAKRsEoGJEAADX1QEKvy7MZAAAAAElFTkSuQmCC","orcid":"","institution":"Rajavithi Hospital, Rangsit University","correspondingAuthor":true,"prefix":"","firstName":"Ittipon","middleName":"","lastName":"Gunnarut","suffix":""},{"id":408985921,"identity":"33d10d91-e4ea-48ab-a016-33ac4cd03bae","order_by":1,"name":"Kritsada Buakate","email":"","orcid":"","institution":"Rajavithi Hospital, Rangsit University","correspondingAuthor":false,"prefix":"","firstName":"Kritsada","middleName":"","lastName":"Buakate","suffix":""}],"badges":[],"createdAt":"2025-01-20 05:55:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5862890/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5862890/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75408972,"identity":"7638add3-f5ee-4322-a829-a330b6c44fe5","added_by":"auto","created_at":"2025-02-04 09:01:48","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":56035,"visible":true,"origin":"","legend":"\u003cp\u003ePterional approach\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5862890/v1/7af1c99887422f345ecbab76.jpeg"},{"id":75408957,"identity":"588ebd2d-e8fc-4e57-8b8a-006412005649","added_by":"auto","created_at":"2025-02-04 09:01:47","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":11947,"visible":true,"origin":"","legend":"\u003cp\u003eMinipterional approach\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5862890/v1/ef82c1abb61b784067cfd90b.jpeg"},{"id":75408968,"identity":"b427c1dc-807a-4e1b-af0d-89eb1e5c7faa","added_by":"auto","created_at":"2025-02-04 09:01:48","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":426803,"visible":true,"origin":"","legend":"\u003cp\u003eTransylvian approach\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5862890/v1/74f57ca813cabdd87023755f.jpeg"},{"id":75829161,"identity":"8b058d47-52e7-4d4b-bc64-8ea0f2886dfd","added_by":"auto","created_at":"2025-02-09 11:16:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1109759,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5862890/v1/7dfea3ed-ee46-4ca1-b1b6-d31f6689a2e6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison between surgical outcomes of the minipterional and pterional approaches in hypertensive intracerebral hemorrhage patients","fulltext":[{"header":"Background","content":"\u003cp\u003eCerebrovascular disease is expected to remain a pervasive issue in the future, presenting significant challenges with its high rates of morbidity and mortality. Intracerebral hemorrhage is of particular concern due to its severe mortality rates; in Thailand, the morbidity and mortality rates are very high, at about 27 percent \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e. Effective interventions range from blood pressure control and surgical management, including craniotomy or craniectomy with hematoma removal, to endoscopic procedures and mini-craniectomy/craniotomy techniques \u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/sup\u003e. Traditionally, the pterional approach has been widely employed in neurosurgery for hypertensive intracerebral hemorrhage, particularly in cases involving the basal ganglia, a common site for hypertensive hemorrhages. Recently, the endoscopic transcranial approach with hematoma removal has been widely used for intracerebral hemorrhage; however, the cost of this modality is very high. The minipterional approach, a refined modification and alternative technique for basal ganglion hemorrhage, has been adopted by numerous neurosurgeons, highlighting some potential benefits over the conventional technique. Lin, Bon-Jour et al. reported good outcomes and hematoma evacuations, but only four patients were included in their study. Another report by the same authors indicated that minipterional craniotomy with a rostral transylvian-transinsular approach is a feasible and effective strategy for managing symptomatic hypertensive basal ganglion hemorrhage. This minimally-invasive surgery provides a high rate of functional independence and is strongly recommended for suitable candidates \u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eObjectives\u003c/h3\u003e\n\u003cp\u003eThis publication aims to compare the clinical outcomes and length of hospital stay resulting from the minipterional and pterional approaches in hypertensive intracerebral hemorrhage, with a particular focus on basal ganglion hemorrhages. Despite numerous publications on the pterional approach for basal ganglion hemorrhage evacuation, there remains a lack of direct comparative studies evaluating the minipterional approach and its potential advantages or disadvantages.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSurgical technique\u003c/h2\u003e \u003cp\u003eThe patient's head is turned to the contralateral side at a 30\u0026ndash;45 degree angle with shoulder elevation, as shown in Picture 1. The frontotemporal incision is then made in the standard fashion; however, in the minipterional approach, the incision is shorter, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The scalp is elevated, and the muscle is cut and elevated. Frontotemporal craniectomy is performed, but mini-craniectomy (estimated 3\u0026ndash;4 cm) is done in the minipterional approach. The dura is opened, and the sylvian fissure is dissected. Cerebrospinal fluid (CSF) is released, and the fissure is dissected using the inside-out technique to expose the insular cortex. Normally, the distal sylvian fissure is only split, and a corticotomy is made in the insular cortex. The hematoma is then removed, and the bleeding point is identified and coagulated. A retractor-less technique is used during hematoma removal. Finally, the dura and the scalp are closed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using SPSS software version 22.0 (SPSS Inc., Chicago, Illinois, USA). The Shapiro\u0026ndash;Wilk test was performed to evaluate the normality of the distribution of the data. Continuous data were presented as mean\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;standard deviations (SD) or median (min-max), while categorical data were presented as number (percent). The student\u0026rsquo;s t test was used to compare the continuous data (for normally distributed data) and Mann\u0026ndash;Whitney tests was utilized for non-normally distributed data. Chi-squared was used to compare the categorical data between two groups, and Spearman's rank correlation coefficient (r\u003csub\u003es\u003c/sub\u003e) was employed to evaluate the magnitude and orientation of the association between two variables. A p value of \u0026le;\u0026thinsp;0.05 was regarded as statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe total number of patients screened for the study was 27, 12 of whom underwent the pterional approach and 15 of whom received the minipterional alternative. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows a comparison of patient characteristics of those who underwent the minipterional and pterional approaches. The data indicates that there was a significant difference between the ages of the two groups; patients who underwent the pterional approach were older than those who underwent the minipterional approach. In contrast, the other characteristics did not show any statistically significant difference.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison between characteristics and clinical outcomes of the pterional and minipterional approaches\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePterional approach (n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMinipterional approach (n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000 \u003csup\u003eB\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (73.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (73.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000 \u003csup\u003eB\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56.3\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.049*\u003csup\u003eA\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntibiotic preoperatively\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000 \u003csup\u003eB\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood preoperatively (cc)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57.0 (32.0-160.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.3 (27.1\u0026ndash;98.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.205\u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGCS preoperatively\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.820\u003csup\u003eA\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eValues represented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, n (%) and median (min-max), * = significant at \u003cem\u003ep\u003c/em\u003e value\u0026thinsp;\u0026le;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003eA\u003c/sup\u003e = The \u003cem\u003ep\u003c/em\u003e value by Student's t-test\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003eB\u003c/sup\u003e = The \u003cem\u003ep\u003c/em\u003e value by Chi-squared test\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003eC\u003c/sup\u003e = The \u003cem\u003ep\u003c/em\u003e value by Mann-Whitney U test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e compares the patient characteristics of those who underwent the minipterional and pterional approaches. The data indicates that the ages of patients in the two groups differed significantly: those who underwent the pterional approach were older than those who received the minipterional approach. However, the other characteristics did not show any statistically significant difference.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison between outcomes of the pterional and mini pterional approaches.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcomes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePterional approach (n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMinipterional approach (n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood post operative (cc)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.6 (0.0-29.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.5 (0.0-33.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.765\u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGCS Post operative (average)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.0 (3.0\u0026ndash;15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.0(10.0\u0026ndash;15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.018*\u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGCS increase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0 (6.0\u0026ndash;9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.0 (2.0\u0026ndash;10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.053\u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital Stay (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.0 (5.0-120.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.0 (3.0\u0026ndash;90.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.434\u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.569\u003csup\u003eB\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eValues represented as n (%) and median (min-max), * = significant at \u003cem\u003ep\u003c/em\u003e value\u0026thinsp;\u0026le;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003eB\u003c/sup\u003e = The \u003cem\u003ep\u003c/em\u003e value by Chi-squared test\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003eC\u003c/sup\u003e = The \u003cem\u003ep\u003c/em\u003e value by Mann-Whitney U test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows that the post-operative Glasgow Coma Score (GCS) after the minipterional approach was better than after the pterional approach (P value 0.018). The GCS was higher in patients who underwent the minipterional approach, but this increase was not statistically significant. In terms of hospital stay, the minipterional approach group had a shorter duration compared to the pterional approach group, while the pterional group had lower residual hematoma than the minipterional group, but these differences were not statistically significant.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors associated with outcomes.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBlood\u003c/p\u003e \u003cp\u003epost operatively\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGCS\u003c/p\u003e \u003cp\u003epost operatively\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHospital stay\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.3 (0.0-33.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.0 (1.0\u0026ndash;15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.0 (3.0-120.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.3 (0.0-18.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.0 (10.0\u0026ndash;15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.0 (5.0\u0026ndash;90.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eP\u003c/b\u003e \u003cb\u003evalue\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.685 \u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.416 \u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.824 \u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.5 (0.0-33.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.0 (1.0\u0026ndash;15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.0 (5.0\u0026ndash;90.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eP\u003c/b\u003e \u003cb\u003evalue\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.341 \u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.394 \u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.814 \u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntibiotic preoperatively\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.7 (0.0-33.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.0 (1.0\u0026ndash;15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78.2 (79.4-361-3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eP\u003c/b\u003e \u003cb\u003evalue\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.067 \u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.859 \u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.208\u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years) (r\u003csub\u003es\u003c/sub\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eP\u003c/b\u003e \u003cb\u003evalue\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.552 \u003csup\u003eD\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.271\u003csup\u003eD\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.898 \u003csup\u003eD\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood preoperatively (r\u003csub\u003es\u003c/sub\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eP\u003c/b\u003e \u003cb\u003evalue\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.851\u003csup\u003eD\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.112 \u003csup\u003eD\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.964 \u003csup\u003eD\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGCS Preoperatively (r\u003csub\u003es\u003c/sub\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.130\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eP\u003c/b\u003e \u003cb\u003evalue\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.815\u003csup\u003eD\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.049 \u003csup\u003eD\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.517 \u003csup\u003eD\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eValues are represented as median (min-max) and Spearman's rank correlation coefficient (r\u003csub\u003es\u003c/sub\u003e),\u003c/p\u003e \u003cp\u003e* = significant at \u003cem\u003ep\u003c/em\u003e value\u0026thinsp;\u0026le;\u0026thinsp;0.05\u003c/p\u003e \u003cp\u003e \u003csup\u003eC\u003c/sup\u003e = The \u003cem\u003ep\u003c/em\u003e value by Mann-Whitney U test\u003c/p\u003e \u003cp\u003e \u003csup\u003eD\u003c/sup\u003e = The \u003cem\u003ep\u003c/em\u003e value by Spearman's rank correlation coefficient (r\u003csub\u003es\u003c/sub\u003e)\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows no association between residual hematoma, post-operative Glasgow Coma Score (GCS), hospital stay, and variables such as sex, comorbidity, preoperative antibiotic use, age, preoperative hematoma volume, and preoperative GCS.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eHypertensive intracerebral hemorrhage is a condition which entails high rates of morbidity and mortality \u003csup\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/sup\u003e. The basal ganglion is the most common location for hemorrhage, and surgical evacuation remains a controversial topic. The benefits of surgical management include a rapid decrease in intracranial pressure and a reduction in brain edema caused by the hematologic reaction. The transylvian approach is one of the best choices for hematologic evacuation, with literature reviews indicating that this approach is better than transcortical resection because it achieves minimal cortex injury and brain edema \u003csup\u003e(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/sup\u003e; however, there have been few comparisons between the minipterional and standard pterional approaches in the context of transylvian evacuation.\u003c/p\u003e \u003cp\u003e1. Hematoma Removal\u003c/p\u003e \u003cp\u003eThe transylvian approach is effective for basal ganglion hematoma evacuation because the bleeding point is directly visible, but it is challenging to remove the entire hematoma volume, especially in higher locations such as the parietal region. In this study, the hematoma evacuation volumes were 5.5 and 2.6 CC in the minipterional and conventional pterional approaches, respectively; this difference was not statistically significant. The percentage of hematoma clearance in this study was comparable to rates reported in other studies. The transylvian-transinsular approach has shown significant improvement in hematoma clearance rates, with past studies reporting over 90% clearance in many cases (Wang et al., 2023; Zhu et al., 2012) \u003csup\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/sup\u003e. Other journals have reported an average clearance from the minipterional approach of around 89.5-94.32% \u003csup\u003e(3,4)\u003c/sup\u003e. In this study, the clearance rates were about 86.3% and 95.4% in the minipterional and conventional pterional approaches, respectively, showing no significant difference from those found in other studies.\u003c/p\u003e \u003cp\u003e2. Clinical Outcomes\u003c/p\u003e \u003cp\u003eThe recovery time for the minipterional approach is theoretically shorter due to the minimal tissue dissection required. This report compared the minipterional and pterional approaches and showed that the hospital stay after the minipterional approach was shorter than after the conventional pterional approach (28 and 41 days, respectively). Post-operative GCS was significantly better following the minipterional approach. This is probably because of the minimal tissue dissection and trauma involved in with the minipterional approach, and it aligns with Lin's findings \u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/sup\u003e. Among other studies, such as those on the transylvian approach, one report found that hospital stays averaged 17.38 days \u003csup\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/sup\u003e, while Minxue Lian reported 18 days for the transylvian group \u003csup\u003e(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/sup\u003e. In this study, hospital stay in both groups was longer than recorded in other studies, probably because of caregiver challenges in home care.\u003c/p\u003e \u003cp\u003e3. Comparison of Transylvian and Transcortical Approaches\u003c/p\u003e \u003cp\u003eOpen surgery's role in managing spontaneous intracerebral hemorrhage remains vague \u003csup\u003e(\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/sup\u003e. However, early removal of basal ganglion hemorrhage is associated with alleviation of neurological insult and improvement in functional outcomes \u003csup\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/sup\u003e. Some reports comparing transcortical and transylvian approaches indicate better recovery outcomes and shorter hospital stays after the transylvian approach \u003csup\u003e(\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/sup\u003e. Wang X reported longer hospital stays for the transcortical approach (average 42 days) than after the transylvian alternative (35 days) \u003csup\u003e(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/sup\u003e. This study's hospital stays for the minipterional approach were shorter than those recorded in Wang\u0026rsquo;s research; this was probably due to the minimal surgical manipulation used in the minipterional transylvian approach.\u003c/p\u003e \u003cp\u003e4. Comparison of minipterional and punctured drainage basal ganglion hemorrhage procedures\u003c/p\u003e \u003cp\u003eThe punctured drainage basal ganglion hemorrhage technique is an alternative procedure for patients with hypertensive basal ganglia hemorrhage, and some reports have shown show that this intervention is effective in treating these patients \u003csup\u003e(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/sup\u003e. The volume of the hematoma after treatment has been found to be significantly lower in patients undergoing the drainage technique than in those receiving the traditional treatment; furthermore, the duration of hospitalization was significantly shorter in drainage patients than in their counterparts receiving the traditional intervention. Compared with the minipterional approach in this report, the residual hematoma of the minipterional group was lower than in the drainage group \u003csup\u003e(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/sup\u003e; however. hospital stay was longer in the minipterional group.\u003c/p\u003e \u003cp\u003e5. Comparison between the outcomes of the minipterional and endoscopic approaches in basal ganglion hemorrhage\u003c/p\u003e \u003cp\u003eAfter the endoscopic approach, average residual hematoma has been reported at about 1.2-6.375 cc \u003csup\u003e(\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/sup\u003e, while hospital stay averaged about 17 days \u003csup\u003e(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/sup\u003e. Following the minipterional approach in this report, the residual hematoma was within the range reported in the other journals, but the hospital stay was longer than after the endoscopic approach.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe minipterional approach is an alternative modality for removal of basal ganglion hemorrhage, yielding shorter hospital stays than the conventional approach together with good outcomes. Future research should include prospective randomized controlled trials comparing the minipterional with the pterional approach or other minimally invasive approaches, such as endoscopic or puncture approaches.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCSF \u0026nbsp; Cerebrospinal fluid\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGCS \u0026nbsp; \u0026nbsp; Glasgow Coma Score\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTG has given substantial contributions to the conception and the design of the manuscript, including analysis and interpretation of data. All authors have participated in drafting the manuscript. TG revised it critically, and all authors read and approve the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSelf-funding by authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the results of this article are included within the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Ethics Committee of Rajavithi Hospital (No. 190/2024).\u003c/p\u003e\n\u003cp\u003eThe authors certify that they have obtained all appropriate consent forms, in which patients gave their permission for their images and other clinical information to be reported in the journal. They were clearly informed that although neither their names nor initials would be published, and all due efforts would be made to conceal their identity, anonymity could not be guaranteed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKongbunkiat K, Kasemsap N, Thepsuthammarat K, Tiamkao S, Sawanyawisuth K. National data on stroke outcomes in Thailand. J Clin Neurosci. 2015;22(3):493\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKandasamy R, Idris Z, Abdullah JM. Surgery of intracerebral hemorrhage. Neurovascular Surgery [Internet]. 2019 [cited 2024 Dec 1]; 1:201\u0026thinsp;\u0026ndash;\u0026thinsp;10. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://link.springer.com/chapter/\u003c/span\u003e\u003cspan address=\"https://link.springer.com/chapter/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/978-981-10-8950-3_24\u003c/span\u003e\u003cspan address=\"10.1007/978-981-10-8950-3_24\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBon-Jour L, Yi-An C, Tzu-Tsao C, Wei-Hsiu L, Chi-Tun T, Dueng-Yuan H, et al. Clinical Efficacy of Minipterional Craniotomy with Rostral Transsylvian-Transinsular Approach for Hypertensive Basal Ganglion Hemorrhage. J Med Sci. 2020;40(4):175\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBon-Jour L, Yi-An C, Tzu-Tsao C, Wei-Hsiu L, Chi-Tun T, Dueng-Yuan H, et al. 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J Neurosurg. 2023;139(6):1784\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee CC, Huang APH, Chen CC, Liu ZH, Yeap MC, Chen KT. Minimally invasive endoscopic evacuation with the novel, portable Axonpen neuroendoscopic system for spontaneous intracerebral hemorrhage Author links open overlay panel. J Clin Neurosci 2024:119:93\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Minipterional, Pterional, Basal ganglion hemorrhage, Glasgow Coma Score","lastPublishedDoi":"10.21203/rs.3.rs-5862890/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5862890/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground \u003c/strong\u003eIntracerebral hemorrhage is a condition which entails high rates of morbidity and mortality. Effective interventions range from conservative treatment to surgical management. The minipterional approach is an alternative, minimally invasive method used to treat various lesions. This report aims to compare the clinical outcomes and length of hospital stay resulting from the minipterional and pterional approaches in basal ganglion hemorrhage.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eDemographic Data: The age of patients who underwent the pterional approach was significantly higher than that of the minipterional group.\u003c/p\u003e\n\u003cp\u003eClinical Outcomes: The minipterional group had better postoperative Glasgow Coma Scores and shorter length of hospital stay than their counterparts in the conventional group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003eThe minipterional approach is an effective alternative for treating hypertensive basal ganglion hemorrhage, yielding shorter hospital stays and better outcomes.\u003c/p\u003e","manuscriptTitle":"Comparison between surgical outcomes of the minipterional and pterional approaches in hypertensive intracerebral hemorrhage patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-04 09:01:37","doi":"10.21203/rs.3.rs-5862890/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2a7028d9-932f-423f-83c0-5ad0c3073a0c","owner":[],"postedDate":"February 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-04T11:23:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-04 09:01:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5862890","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5862890","identity":"rs-5862890","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}