Comparative analysis of stereotactic aspiration via supraorbital keyhole versus Kocher’s point for basal ganglia intracerebral hematoma: computational simulation and propensity score-matched study

Catheter placement via the supraorbital keyhole (SOK) for removing spontaneous intracerebral hemorrhage (sICH) in the basal ganglia may result in improved aspiration rates and functional outcomes than those by the conventional Kocher's point (KP) route. Verification was performed using he results of computational simulations and retrospective clinical data matched by propensity scores. We retrospectively enrolled 50 patients who underwent stereotactic hematoma aspiration of 'typical' shape of basal ganglia sICH. After propensity score matching (PSM), comparative analyses between the two groups (n = 36) were performed. A computational simulation of hematoma aspiration was conducted in eight patients using 2-mm thin-sliced brain computed tomography images obtained preoperatively. After PSM, eighteen patients in each group were newly matched and the logit propensity score of the was 0.04 ± 0.0726. The aspiration rate was significantly higher in the SOK group (31.841 ± 40.131 in KP vs. 55.191 ± 25.387 in SOK, p = 0.045), and the proportion of patients who achieved good functional outcomes (mRS score, 0-2 at 6 months) was significantly higher in the SOK group (27.8% vs. 61.1%, p = 0.044). The computational simulations also demonstrated a lower residual volume rate in the SOK group than in the KP group in those with a typical ICH type (21.5% vs. 43.4%). Stereotactic hematoma aspiration via the SOK route in patients with typical basal ganglia ICH is a safe and effective method with an enhanced aspiration rate and favorable functional outcomes.