Individualized surgical management of supratentorial hypertensive intracranial hemorrhage: a retrospective study using 3D Slicer and diffusion tensor imaging.

Background: This study aims to evaluate the outcomes of individualized surgical interventions tailored to patients with non-traumatic supratentorial intracranial hemorrhage.

Methods: A retrospective cohort study reviewed patients with intracranial hemorrhage who underwent surgical intervention between January 2020 and December 2023. All patients received pre- and post-operative brain computed tomography scans. Three-dimensional (3D) anatomical models of the brain and hematoma were generated using the 3D Slicer software to determine the optimal surgical trajectory in most patients. In addition, some patients underwent magnetic resonance diffusion tensor imaging. Surgical strategies for hematoma evacuation were selected based on each patient's neurological status, hemorrhage location, and hematoma volume. Post-operative neurological function was assessed using the modified Rankin scale.

Results: A total of 196 patients were included in the study. Among them, 97 patients underwent surgical drilling with catheter drainage, 37 patients received small bone window craniotomy with hematoma removal via the Sylvian fissure, 6 patients underwent neuroendoscopic hematoma evacuation, 31 patients received small bone window craniotomy via the cortex, and 25 patients underwent lateral ventricular puncture with drainage. The proportion of patients with an mRS score ≤ 3 was 48.0% at three months and 70.3% at one year post-operatively. Compared with patients who underwent conventional drilling and hematoma drainage, those who received hematoma evacuation guided by 3D Slicer modeling demonstrated better neurological function at three and twelve months post-operatively. Post-operative measurements of the posterior limb of the internal capsule were significantly higher than pre-operative measurements, indicating improved microstructural integrity of white matter tracts and enhanced neurological function. The incidences of post-operative re-bleeding and infection were low, at 2.5% and 1.0%, respectively.

Conclusions: Individualized surgical management, considering patient neurological status, hemorrhage location, and hematoma volume, and utilizing 3D Slicer modeling and diffusion tensor imaging analysis, should be considered for hematoma evacuation in patients with supratentorial intracranial hemorrhage.