Aspiration of Hypertensive Intracerebral Hematoma with Frameless and Fiducial-Free Navigation System: Technical Note and Preliminary Result

Stereotactic aspiration of hematoma is an effective method for the treatment of basal ganglia hematoma. Hematoma aspiration with a frameless navigation system using external fiducials has been published in the literature. But the literature is lacking in the use of a fiducial-free method for frameless aspiration of hematoma. We report an effective and safe method for the aspiration of intracerebral hematoma with a frameless and fiducial-free navigation system. Methods: Six patients with hypertensive basal ganglia hematoma underwent stereotactic aspiration of hematoma with a frameless and fiducial-free navigation system during January 2007 to April 2007. Patient registration to 3D data was done with surface matching. An articulated holder was used to maintain the trajectory. A catheter was inserted into the hematoma through the trajectory. Urokinase was injected into the hematoma. CT scan was performed after a few days of hematoma drainage. The pre- and postoperative hematoma volume and neurological function were compared. Results: The patients' GCS improved from an average of 11.25 to an average of 14.83 after several days of hematoma drainage. Brain CT carried out after several days of drainage showed a 68-100% (average 79.3%) reduction of hematoma. No surgery-induced complication was noted. Conclusion: The use of a frameless and fiducial-free navigation system appears to be a time-efficient, safe, and effective method for the aspiration of hypertensive intracerebral hematoma. Copyright (C) 2008 S. Karger AG, Basel