A Comparative Study of the Efficacy of Transfrontal Keyhole Approach Under Neuroendoscopy versus Microsurgical Translateral Fissure-Insular Approach for Treating Basal Ganglia Haemorrhage
LIANG Xiaobo, YUAN Ruizhi, LIU Jianpeng, et al
Yuncheng Central Hospital Affiliated to Shanxi Medical University, Shanxi Yuncheng 044000, China
Abstract：Objective: To investigate the effects of transfrontal keyhole approach and microsurgical translateral fissure-insular approach on the treatment of basal ganglia haemorrhage and their impact on the levels of serum heart-type fatty acid-binding protein (h-FABP), aquaporin 4 (AQP4), and astrocyte calcium-binding protein (S100β). Methods: A total of 196 patients with intracerebral hemorrhage in basal ganglia region admitted to Yuncheng Central Hospital Affiliated to Shanxi Medical University from January 2022 to October 2024 were selected and divided into two groups according to different surgical methods, 98 patients in the endoscopic group underwent neuroendoscopic hematoma removal (neuroendoscopic surgery), and 98 patients in the microscopic group underwent microscopic hematoma removal (microscopic surgery). The hematoma clearance effect and surgical indexes of the two groups were observed. The levels of serum perioperative brain injury factors (h-FABP, AQP4, S100β) were detected by enzyme-linked immunosorbent assay. The neurological function [National Institutes of Health Stroke Scale (NIHSS) scores], activities of daily living (ADL), prognosis [Glasgow Outcome Scale (GOS)] before operation, 3 months, and 6 months after operation, and incidence of complications were compared between the two groups. Results: There was no significant difference in the total clearance rate of hematoma between the two groups (P>0.05). The complete clearance rate of the microscope group was 63.27%, which was higher than the endoscopic group at 45.92%, and the difference was statistically significant (χ2= 5.269, P=0.022). The operation time of the endoscopic group was (98.41±12.16) min, which was shorter than the microscopic group at (138.52±18.79) min, and the intraoperative blood loss was (90.27±10.28) mL, less than the microscopic group at (106.43±13.64) mL, the differences were statistically significant (t=17.741, 9.366, all P<0.001); At 1 d and 3 d after operation, the serum h-FABP levels in the endoscopic group were (20.15±3.25)μg/L and (15.41±3.12)μg/L, respectively, lower than the microscopic group at (24.73±4.39)μg/L and (20.03±4.07)μg/L. The levels of AQP4 were (1.32±0.22)ng/L and (0.85±0.17)ng/L, respectively, lower than the microscopic group at (1.61±0.28)ng/L and (1.04±0.21)ng/L. The levels of S100β were (1.25±0.27)μg/L and (0.89±0.23)μg/L, respectively, lower than the microscope group at (1.54±0.35)μg/L and (0.98±0.26)μg/L. The differences were statistically significant (t=8.301, 8.918, 8.062, 6.962, 6.495, 4.278, all P<0.001). At 6 months after operation, the NIHSS score of the microscope group was (6.11±0.83), lower than the endoscopic group at (7.02±0.91), and the ADL score was (81.12±3.62), higher than the endoscopic group at (77.29±3.90), the differences were statistically significant (t=7.314, 7.125, all P<0.001). At 6 months after operation, the prognosis of the microscopic group was better than that of the endoscopic group, and the difference was statistically significant (u=2.001, P=0.045). The incidence of complications in the endoscopic group was 4.08%, lower than the microscopic group at 12.24%, the difference was statistically significant (χ2=4.356, P=0.037). Conclusion: Neuroendoscopic surgery and microscope surgery each have their advantages and disadvantages in the treatment of basal ganglia haemorrhage. Neuroendoscopic surgery can optimize the surgical process and reduce early brain damage, while microscope surgery can improve the complete removal rate of hematoma, achieve better effects in terms of long-term neurological function and prognosis improvement in patients, and offer higher safety. Clinically, the surgical method should be selected based on the actual situation of the patient.
梁晓波, 原睿智, 刘健鹏, 秦梦阳. 神经内镜下经额锁孔入路与显微镜下经外侧裂-岛叶入路治疗基底节区脑出血的效果对比研究[J]. 河北医学, 2026, 32(1): 85-92.
LIANG Xiaobo, YUAN Ruizhi, LIU Jianpeng, et al. A Comparative Study of the Efficacy of Transfrontal Keyhole Approach Under Neuroendoscopy versus Microsurgical Translateral Fissure-Insular Approach for Treating Basal Ganglia Haemorrhage. HeBei Med, 2026, 32(1): 85-92.
2026, Vol. 32 
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