Objective To evaluate the clinical value of midfrontal keyhole approach for the treatment of severe intra-ventricular hematoma. Methods The clinical data of 21 cases of severe intraventricular hemorrhage through midfrontal key-hole approach were analyzed retrospectively. Results Both inside and outside intraventricular hematoma were satisfied cleared. The GCS score and intraventricular hemorrhage Graeb score were improved. There were complications after opera-tion including 1 patient with diffuse brain swelling, 3 patients with cerebral vasospasm, 1 patient with intracranial infection, and seven patients with pulmonary infection. Follow-up schedules included 1-6 months. According to ADL score, 5 patients recovered well, 9 patients were moderately disabled, 3 were severely disabled, 1 was in a vegetative state and 3 died. Conclu-sion The intraventricular hematoma can be removed through midfrontal keyhole approach. The obstructive hydrocephalus can be relieved, the secondary brain damage was reduced and the prognosis was improved in patients.

Objective To explore the effect of secondary brain injury(SBI) in high-risk factors and brain malignant encephaiocele during surgical operation for severe traumatic brain injury. Methods Carried on the grouping graduation to 112 patients with severe traumatic brain injury according to SBI's high-risk factors:non-high-risk factors group (pure group) 23 cases, high-risk factors group (SBI group) 89 cases, 1 level of high-risk factors group had 27 cases, 2 level of high-risk factors group had 28 cases, 3 level of high-risk factors group had 34 cases. Results Carried on the comprehensive therapy regarding the above patients, the brain malignant encephalocele rate in the SBI group and the pure group was 59.55% (53/89) and 13.04%(3/23) respectively, there was significant statistics differences in the two groups,1 level and 2 level of high-risk factors group of brain malignant encephalocele rate was 40.74% (11/27) and 53.57% (15/28) respectively, the difference was not obvious statistics significance, 2 level and 3 level of high-risk factors group of brain malignant eneephalocele rate was 53.57%(15/28) and 79.41%(27/34) respectively, the difference was obvious statistics significance. Conclusions The SBI's high-risk factors are the important factors affecting severe craniocerebral injury encephalocele. Taking adequate pre-operative assessment, carrying a comprehensive treatment on the patients combine with high-risk factors of SBI can greatly reduced the incidence of brain malignant encephalocele during surgical operation if the high-risk factors of SBI is controlled.

According to the locations of main hematomas,60 patients with hypertensive basal ganglia hemorrhage were surgically treated through different approaches from June 2014 to September 2017.Thirty six cases with anterior hematoma near the Sylvian point were treated through transsylvian-transinsular approach,24 cases with the posterior hematoma far from the Sylvian point were treated through translower-rolandic-point (transLRP) transinsular approach (n =11) or transsuperior-temporal-sulcus (transSTS) transinsular approach (n =13),respectively.All patients were followed up for at least 6 months and evaluated by Glasgow Outcome Scale.Fourteen patients showed good recovery,25 patients showed moderate disability,18 patients showed severe disability,one patients showed vegetative survival and two patients died.

Objective To compare the clinical effect of the small bone flap craniotomy and traditional craniotomy in the treatment of elderly patients with hypertensive striatocapsular hemorrhage .Methods According to the digital table ,80 patients with hypertensive striatocapsular hemorrhage were randomly divided into control group and treatment group ,40 cases in each group .The treatment group was treated with small bone flap craniotomy ,and the control group was treated with traditional craniotomy .The operative incision length ,intraoperative blood loss ,operation time,hematoma clearance rate,rebleeding rate,GCS score,postoperative pulmonary infection rate and GOS score in the 1 month after treatment were compared between the two groups .Results The operative incision length , intraoperative blood loss, operative time, GCS score after 1 week, pulmonary infection of the treatment group were (7.0 ±1.5)cm,(100 ±35)mL,(1.5 ±0.6)h,(12.5 ±1.4),25.0％,respectively,which of the control group were (18.0 ±4.5)cm,(500 ±85) mL,(2.2 ±0.8) h,(10.5 ±1.1),47.5％,respectively,the differences between the two groups were statistically significant (t=303.791,P=0.000;t=244.467,P=0.000;t=24.366,P=0.003;t=3.294,P=0.031;χ2 =4.381,P=0.036).The hematoma clearance rate,rebleeding rate of the treatment group were 90.0％,7.5％,respectively,which of the control group were 85.0％,10.0％,respectively,there were no statistically significant differences between the two groups (χ2 =0.457,P=0.499;χ2 =0.157,P=1.692).The prognosis of the patients in the treatment group was significantly better than those in the control group (Z=-2.022,P=0.043). Conclusion The small bone flap craniotomy in the treatment of hypertensive striatocapsular hemorrhage has the advantages of less trauma , shorter operative time , less intraoperative bleeding , high hematoma clearance rate , low rebleeding rate,low complication rate and good prognosis .

Objective: To study the surgical strategy and clinical efficacy of hypertensive basal ganglia hematomas via transsylvian transinsular approach individually. Methods: The clinical data of 45 patients with hypertensive basal ganglia hematomas underwent microsurgical treatment with different sylvian anatomical points in Jianhu Hospital Affiliated to Nantong University from October 2014 to June 2016 were retrospectively analyzed. Results: The anterior hematomas was dissected through anterior point of lateral fissure, accounted for 66.7%(30 cases), the posterior hematoma was dissected through rolandic points under lateral fissure, accounted for 22.2%(10 cases), the long axis type hematoma was dissected between the anterior point of the lateral fissure and the lower rolandic point, accounted for 11.1%(5 cases). The postoperative CT scan showed that 42 cases were removed the hematomas for more than 90.0%, 3 cases were removed the hematomas for more than 75.0%, there was no postoperative rebleeding.According to GOS score, 14 cases returned to preoperative life status, 20 cases recovered sufficiently to return to family life, 9 cases could ambulate with a crotch but needed assistance, one case showed vegetative survival, one patient died. Conclusion Transsylvian transinsular approach via individual sylvian anatomical point should be advocated to remove basal ganglia hematomas, and it has the advantages of minimally invasion, high hematoma evacuation rate, low rebleeding rate, good neurological recovery and so on.