Abstract: Objective To compare the clinical efficacy of neuro-endoscopy trans posterior middle frontal gyrus parallel the white matter fiber tracts with microscopic craniotomy in the treatment of basal ganglia hemorrhage,and to optimize the treatment of the basal ganglia hemorrhage.Methods A total of 69 patients with basal ganglia hemorrhage that meet the inclusion criteria treated by operation between September 2019 and February 2021 were analyzed retrospectively.According to the different surgical methods,the patients were divided into endoscopic group(35 patients) and craniotomic group(34 patients).Compare the perioperative index and complete the DTI 3 weeks after surgery to evaluate the fiber tracts of the patients.And evaluate the aphasia and the ADL score 6 months later.Results The operative time、blood loss on endoscopic group was significantly better than the craniotomy group(P＜0.001).The the aphasia of the endoscopic group is better than the craniotomic group(P＜0.05).The protection of the white matter tracts and the ADL scores of the endoscopic group are also significantly better than craniotomic group(P＜0.001).Conclusion Neuro-endoscopy trans posterior middle frontal gyrus parallel the white matter fiber tracts is safer、faster、less hemorrhage,and have a good protection of the fiber tracts.The patients have a better neurological recovery and outcome.

Key words: Neuro-endoscopy, Posterior middle frontal gyrus, The white matter fiber tracts, Basal ganglia hemorrhage

摘要： 目的 探讨神经内镜经额中回平行大脑白质纤维束入路与开颅显微镜治疗基底节区脑出血的临床疗效研究,优化基底节区脑出血的临床治疗方案。方法 回顾性分析2019年9月至2021年2月在期间收治的69例符合入选标准的基底节区脑出血患者,按照手术治疗方式的不同,分为神经内镜经额中回后部平行大脑白质纤维束入路(内镜组)35例以及开颅显微镜下血肿清除术(开颅组)34例,比较两组患者的围手术期情况,术后3周完善磁共振扩散张量成像(DTI)检查评估患者大脑白质纤维束情况;术后6个月后完善失语情况评价及日常生活能力量表(ADL)评分评估患者预后情况。结果 内镜组的手术时间、术中出血量明显优于开颅组(P＜0.001);内镜组的术后6个月失语发生率低于开颅组(P＜0.05),内镜组的大脑白质纤维束保护及ADL评分明显优于开颅组(P＜0.001)。结论 神经内镜经额中回后部平行大脑白质纤维束入路治疗基底节区脑出血较开颅显微镜下血肿清除术更为安全、有效、出血量少且对患者大脑白质纤维束有着很好的保护,患者的预后及神经功能恢复更好。

关键词: 神经内镜, 额中回后部, 白质纤维束, 基底节区脑出血