Transsylvian and paratransylvian approach at non-traumatic intracerebral hematomas of cerebral hemispheres (microanatomic justification and clinical observations)

Abstract

Purpose. To study microsurgical anatomy of lateral (sylvian) cistern (LC) of the brain, to evaluate first clinical results of transsylvian and paratranssylvian approach in removal of non-aneurysmal non-traumatic intracerebral hematomas (NICH).Materials and methods. The LC microsurgical anatomy was studied on 20 macropreparations of cerebral hemispheres. Transsylvian and paratranssylvian approaches were used in 12 patients with lobar (in 10) and lateral-putemenal (in 2) NICH in LC region or projection. We used pterional craniotomy with resection of the crest of sphenoid wing and basal part of the temporal bone.Results. LC length and depth, architecture of insula vessels were studied. The postoperative mortality was 25%. Functional state after 6 months was eatimated as 4 points according to Glasgow Outcome Scale.Conclusions. LC microsurgical anatomy features allow to remove non-aneurysmal NICH, using transsylvian and paratranssylvian approaches.