Application of a Simplified Bregma-Preauricular Depression-Based Localization Technique for Basal Ganglia Hematoma Evacuation via the Middle Frontal Gyrus Approach.

Abstract

To evaluate the feasibility and efficacy of a simplified surface-based localization technique, utilizing the bregma-preauricular depression axis, for basal ganglia hematoma evacuation via the middle frontal gyrus surgical approach. A retrospective analysis was conducted on 33 cases of basal ganglia intracerebral hemorrhage treated between January and December 2024. All procedures were performed via the middle frontal gyrus. The bregma-preauricular depression-guided method was used for preoperative localization of the intraventricular foramen. Utilizing computed tomography imaging and basic instruments (tape measure and skin marker), this technique determined the hematoma's coordinates and guided the puncture trajectory and depth. Hematoma cavities were punctured successfully on the first attempt in all cases. Surgical duration ranged from 65 to 93 minutes (mean 79.5 ± 6.9 minutes), with intraoperative blood loss between 5 and 30 ml (mean 14.4 ± 6.4 ml). Hematoma evacuation rates reached 89%-100% (mean 96.8 ± 2.8%). Initial Glasgow Coma Scale scores ranged from 5 to 15 (mean 8.21 ± 2.41), increasing to 7-15 (mean 12.4 ± 2.6) three months postoperatively. Glasgow Coma Scale score improvement was observed in all patients, with gains ranging from 2 to 7 (mean 4.2 ± 1.5). At discharge, 13 patients (39.4%) achieved a Glasgow Outcome Scale score ≥4, which increased to 22 patients (66.7%) at three months postoperatively. No deaths occurred. The bregma-preauricular depression localization method is a simple and highly accurate technique that provides reliable guidance for hematoma puncture, especially in emergency settings and resource-limited environments. Although promising for its clinical practicality, further prospective investigation is crucial to definitively establish the method's efficacy and safety before its widespread implementation.