Feasibility and Safety of Stereotactic Hematoma Aspiration via Supraorbital Keyhole Route in Patients With Basal Ganglia Spontaneous Intracerebral Hemorrhage: A Single Center Retrospective Analysis.

Abstract

Background: Stereotactic hematoma aspiration surgery was introduced to mitigate the mass effect and subsequent secondary injuries caused by spontaneous intracerebral hemorrhage (sICH) in the basal ganglia. This study posited that the supraorbital keyhole (SOK) route, along with its longer axial trajectory, may achieve improved hematoma aspiration rates and functional outcomes compared with the traditional Kocher's point (KP) route for the evacuation of hematomas in the basal ganglia.

Methods: Seventy-six patients were enrolled between January 2010 and December 2021 (KP [n = 41] and SOK [n = 35]). Frameless stereotactic hematoma aspiration was performed under a neurosurgical navigation system. Comparison analyses of radiologic and clinical data and logistic regression analyses for identifying the parameters of "well-aspirated (> 70%)" were performed. Additionally, subgroup analyses (KP [n = 22] and SOK [n = 28]) were performed in patients with "typical" shape of hematomas.

Results: In the comparative analyses, the aspiration rate of the hematoma was lower in the SOK group (50.71% vs. 38.49%) than that in the KP group; however, this difference was not significant (P = 0.077). In the subgroup analysis, the aspiration rate was significantly higher in the SOK group than that in the KP group (52.6% vs. 33.6%, P = 0.039), and good functional outcomes (modified Rankin Scale score, 0-2) were significantly higher in the SOK group (71.4% vs. 28.6%, P = 0.049) than those in the KP group. Univariate and multivariate logistic regression analyses identified "lesser midline shifting" and "SOK approach" as the significant predictors of better aspiration rates (> 70%), suggesting that these factors are beneficial for achieving optimal surgical outcomes.

Conclusion: Considering the unique lentiform shape and deep-seated location of basal ganglia sICH, stereotactic aspiration of the SOK route is recognized for its safety and efficacy in achieving a high rate of hematoma aspiration.