Kim Jang Hun, Lee Seongwoo, Park Dong-Hyuk, Kang Shin-Hyuk, Park Kyung-Jae
Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2025 Jul 21;40(28):e159. doi: 10.3346/jkms.2025.40.e159.
Stereotactic hematoma aspiration surgery was introduced to mitigate the mass effect and subsequent secondary injuries caused by spontaneous intracerebral hemorrhage (sICH) in the basal ganglia. This study posited that the supraorbital keyhole (SOK) route, along with its longer axial trajectory, may achieve improved hematoma aspiration rates and functional outcomes compared with the traditional Kocher's point (KP) route for the evacuation of hematomas in the basal ganglia.
Seventy-six patients were enrolled between January 2010 and December 2021 (KP [n = 41] and SOK [n = 35]). Frameless stereotactic hematoma aspiration was performed under a neurosurgical navigation system. Comparison analyses of radiologic and clinical data and logistic regression analyses for identifying the parameters of "well-aspirated (> 70%)" were performed. Additionally, subgroup analyses (KP [n = 22] and SOK [n = 28]) were performed in patients with "typical" shape of hematomas.
In the comparative analyses, the aspiration rate of the hematoma was lower in the SOK group (50.71% vs. 38.49%) than that in the KP group; however, this difference was not significant ( = 0.077). In the subgroup analysis, the aspiration rate was significantly higher in the SOK group than that in the KP group (52.6% vs. 33.6%, = 0.039), and good functional outcomes (modified Rankin Scale score, 0-2) were significantly higher in the SOK group (71.4% vs. 28.6%, = 0.049) than those in the KP group. Univariate and multivariate logistic regression analyses identified "lesser midline shifting" and "SOK approach" as the significant predictors of better aspiration rates (> 70%), suggesting that these factors are beneficial for achieving optimal surgical outcomes.
Considering the unique lentiform shape and deep-seated location of basal ganglia sICH, stereotactic aspiration of the SOK route is recognized for its safety and efficacy in achieving a high rate of hematoma aspiration.
立体定向血肿抽吸手术被引入以减轻基底节区自发性脑出血（sICH）所引起的占位效应及随后的继发性损伤。本研究认为，眶上锁孔（SOK）入路因其更长的轴向轨迹，与传统的Kocher点（KP）入路相比，在清除基底节区血肿时可能实现更高的血肿抽吸率及更好的功能预后。
2010年1月至2021年12月期间纳入76例患者（KP组[n = 41]和SOK组[n = 35]）。在神经外科导航系统下进行无框架立体定向血肿抽吸。对影像学和临床数据进行比较分析，并进行逻辑回归分析以确定“抽吸良好（> 70%）”的参数。此外，对血肿呈“典型”形状的患者进行亚组分析（KP组[n = 22]和SOK组[n = 28]）。
在比较分析中，SOK组的血肿抽吸率低于KP组（50.71%对38.49%）；然而，这种差异无统计学意义（P = 0.077）。在亚组分析中，SOK组的抽吸率显著高于KP组（52.6%对33.6%，P = 0.039），且SOK组的良好功能预后（改良Rankin量表评分，0 - 2）显著高于KP组（71.4%对28.6%，P = 0.049）。单因素和多因素逻辑回归分析确定“较小的中线移位”和“SOK入路”是更高抽吸率（> 70%）的显著预测因素，表明这些因素有利于实现最佳手术效果。
考虑到基底节区sICH独特的豆状形状和深部位置，SOK入路的立体定向抽吸在实现高血肿抽吸率方面的安全性和有效性得到认可。
