Portable Ultrasound-Guided Keyhole Evacuation of Intracerebral Hemorrhage: Technical Case Report

Intracerebral hemorrhage (ICH) is a critical neurosurgical emergency with high rates of morbidity and mortality. In recent years, minimally invasive techniques, such as endoscopic hematoma evacuation, have become promising alternatives to traditional large craniotomies. However, achieving accurate trajectory planning and optimal placement of the tubular retractor has been a persistent challenge. In this report, we present a novel approach using handheld portable ultrasound to guide minimally invasive endoscopic evacuation of supratentorial hematomas. The case involved a 64-year-old male diagnosed with a 48.5 mL right basal ganglia hematoma. Emergency surgery was performed using ultrasound-guided endoscopic transtubular evacuation through a small craniotomy. The use of portable ultrasound allowed for precise placement of the tubular retractor along the long axis of the hematoma, facilitating near-total evacuation while minimizing tissue damage. This technique reduced the need for retractor repositioning or “wanding,” which often leads to iatrogenic injury. Recent advances in portable phased array ultrasound probes, offering enhanced resolution and image clarity, have expanded ultrasound’s utility in neurosurgery. These portable devices are proving invaluable in ensuring accurate navigation during minimally invasive procedures, optimizing patient outcomes, and minimizing the invasiveness of the intervention. This case demonstrates the potential of portable ultrasound technology in neurosurgical applications, particularly in emergency interventions like ICH evacuation.