Supraorbital Keyhole Neuroendoscopic Evacuation for Selected Basal Ganglia Intracerebral Hemorrhage: A Preliminary Technical Case Series.

Abstract

To explore optimized minimally invasive strategies for the treatment of spontaneous intracerebral hemorrhage (sICH) in the basal ganglia, this study describes the technical feasibility and preliminarily experience of the supraorbital keyhole (SOK) approach combined with neuroendoscopic hematoma evacuation in anatomically selected patients. This preliminary technical report retrospectively analyzed 5 consecutive patients with basal ganglia sICH who were admitted between September 2025 and February 2026 and met predefined anatomical selection criteria, including a hematoma long axis parallel to the midline. Intraoperatively, neuronavigation was used to plan the surgical trajectory, and hematoma evacuation and hemostasis were performed under direct visualization through a small supraorbital bone window. The results showed that all 5 procedures were completed successfully. The median operative time was 245 min (range, 125-285 min), and the median intraoperative blood loss was 50 mL. The median hematoma evacuation rate was 90% (mean, 74%), with 3 patients (60%) achieving an evacuation rate of ≥90%. No postoperative rebleeding in the operative field or cerebrospinal fluid leakage was observed. One patient with severe ventricular casting developed postoperative intracranial infection and had an unfavorable short-term outcome (Glasgow Outcome Scale score 2). At follow-up, the remaining 4 patients had GOS scores of 3-4. In this small preliminary series, the SOK approach combined with neuroendoscopic techniques appears technically feasible for anatomically selected basal ganglia sICH. Further validation of its safety and clinical effectiveness in larger retrospective studies is warranted.