6th Edition of Neurology World Conference 2026

Abstract

Introduction

Regarding the recent trials, minimally invasive techniques of frameless stereotactic hematoma aspiration is known as a safe and effective method to remove acute intracerebral hemorrhages (ICH), with the potential to enhance neurological recovery. Supraorbital keyhole (SOK) surgeries for the anterior skull base approach were widely used, and the ventriculostomy via the basal frontal lobe was attempted with acceptable safety and feasibility. Considering the anatomic location and shape of basal ganglia, catheter placement via SOK can have a larger length within the hematoma and can lead to better aspiration rate and functional outcomes compared to the conventional Kocher’s point (KP) approach; however, no studies on this topic exist. Verifications with retrospective clinical data and computational simulation were attempted.

Methods

We retrospectively enrolled 76 patients who underwent hematoma aspiration of basal ganglia ICH and divided them into KP and SOK groups. Clinical comparison between the groups and subgroup analysis within typical basal ganglia ICH patients (n=50) were performed. In 8 cases, computational simulation of hematoma aspiration was conducted with preoperative 2mm thinly sliced brain computed tomography images.

Results

In comparison analyses between KP and SOK, the aspiration rate of the hematoma was much lower in SOK groups (50.71% vs. 38.49%); however, the significance was not observed (p=0.077). In subgroup analysis, the aspiration rate was significantly higher in the SOK group than that of the KP group (52.6% vs. 33.6%, p=0.0391), and good functional outcome (modified Rankin Scale score: 0 to 2) was significantly higher in the SOK group (71.4% vs. 28.6%, p=0.049). In computational simulations, residual volume was much lower in SOK patients with a typical type of ICH.

Conclusion

Stereotactic hematoma aspiration via the SOK route in patients with the typical shape of basal ganglia ICH was identified as a safe and effective method with enhancing better aspiration rate and favorable functional outcomes. In computational simulations, residual volume was much lower in typical basal ganglia ICH patients.