To study the efficacy and safety of temporal cortical approach, fissuremicrosurgery and trepanation and drainage in the treatment of supratentorial hypertensive intracerebral hemorrhage (SICH).

A total of 194 patients with SICH from May 2016 to May 2018 were chosen as research object. According to surgical procedures, the patients were divided into temporal lobe group (62 cases), lateral fissure group (47 cases) and trepanation group (85 cases). The perioperative indicators, short-term and long-term surgical effects and occurrence of postoperative complications were compared among the three groups.

There were significant differences in the operative time, intraoperative blood loss and average hospital stay among the three groups (P<0.05). The operative time in lateral fissure group was significantly higher than that in temporal lobe group (P<0.05), and the intraoperative blood loss and average hospital stay were significantly lower than those in temporal lobe group (P<0.05). The operative time in trepanation group was significantly lower than that in temporal lobe group and lateral fissure group (P<0.05), and the intraoperative blood loss and average hospital stay were significantly lower than those in temporal lobe group and higher than those in temporal lobe group(P<0.05), However there was no significant difference in the clearance rate of hematoma among the three groups (P<0.05). The Glasgow Coma Scale (GCS) scores in the three groups were increased gradually with time, and the difference was statistically significant at different time points (P<0.05). The GCS scores in temporal lobe group were higher than those in trepanation group on 1 d and 3 d after operation (P<0.05), and the GCS scores in lateral fissure group on 1 d and 3 d after operation were significantly higher than those in temporal lobe group and trepanation group (P<0.05). The good prognosis rates in the three groups were 87.10%, 91.49% and 80.00% respectively (P>0.05). In addition, there was 1 case of death (1.61%) in temporal lobe group, and there was no death in lateral fissure group, and there were 3 cases of death (3.53%) in trepanation group, and there were no significant differences in the surgical effects among the three groups (P>0.05). The incidences of pulmonary infection and epilepsy in lateral fissure group were significantly lower than those in temporal lobe group (P<0.05). There were no significant differences in the incidences of intracranial rebleeding, stress ulcer and intracranial infection among the three groups (P>0.05).

Temporal cortical approach, fissure microsurgery and trepanation and drainage have good effects in the treatment of SICH. Fissure microsurgery has relatively small trauma, and it is beneficial to improving the short-term efficacy, reducing postoperative complications and promoting rehabilitation.

Supratentorial hypertensive intracerebral hemorrhage; Temporal cortical approach; Fissure microsurgery; Trepanation and drainage; Efficacy; Safety