Trajectories for Freehand-Guided Aspiration of Deep-Seated Spontaneous Intracerebral Hemorrhage

OBJECTIVE: Although external landmarks and trajectories for external ventricular drainage have been described for the freehand-guided method, no standard trajectory has been reported for deep-seated intracerebral hemorrhage (ICH). This article presents a freehand-guided catheter insertion technique for deep-seated spontaneous ICH using external landmarks. METHOD: Freehand-guided hematoma aspiration using Kocher's point and the external auditory canal as landmarks was performed in 32 patients with a diagnosis of spontaneous ICH in basal ganglia treated between May 2015 and July 2018 at the author's institute. RESULTS: In computed tomographic images, the mean actual to planned catheter tip distance was 16.1 +/- 7.7 mm, the mean right-left deviation was 4.6 +/- 5.2 mm, the mean anterior-posterior deviation was 11.1 +/- 1- 9.5 mm, and the mean superior-inferior deviation was 8.7 +/- 4.4 mm. On largest hematoma slice, the mean distance from hematoma centers to inserted catheter was 9.8 +/- 4.9 mm, and the mean horizontal and vertical distances were 4.0 +/- 4.7 mm and 7.7 +/- 4.8 mm, respectively. In 29 of the 32 patients, all the catheter holes contacted hematomas, whereas in the other 3 patients, 1 or more holes were in contact with brain parenchymal tissue. CONCLUSION: For patients with basal ganglia hemorrhage, freehand-guided catheter insertion and hematoma aspiration with subsequent fibrinolysis is a feasible procedure that shortens procedural times. The described technique could be used as an alternative method because it can be performed when the patient is in a critical state without additional equipment.