Aspiration of hypertensive intracerebral hematoma with frameless and fiducial-free navigation system: technical note and preliminary result.
Stereotactic aspiration of hematoma is an effective method for the treatment of basal ganglia hematoma. Hematoma aspiration with a frameless navigation system using external fiducials has been published in the literature. But the literature is lacking in the use of a fiducial-free method for frameless aspiration of hematoma. We report an effective and safe method for the aspiration of intracerebral hematoma with a frameless and fiducial-free navigation system.


METHODS
Six patients with hypertensive basal ganglia hematoma underwent stereotactic aspiration of hematoma with a frameless and fiducial-free navigation system during January 2007 to April 2007. Patient registration to 3D data was done with surface matching. An articulated holder was used to maintain the trajectory. A catheter was inserted into the hematoma through the trajectory. Urokinase was injected into the hematoma. CT scan was performed after a few days of hematoma drainage. The pre- and postoperative hematoma volume and neurological function were compared.


RESULTS
The patients' GCS improved from an average of 11.25 to an average of 14.83 after several days of hematoma drainage. Brain CT carried out after several days of drainage showed a 68-100% (average 79.3%) reduction of hematoma. No surgery-induced complication was noted.


CONCLUSIONS
The use of a frameless and fiducial-free navigation system appears to be a time-efficient, safe, and effective method for the aspiration of hypertensive intracerebral hematoma.
Chen
Chien-hua
CH
Department of Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
Lee
Hsu-tung
HT
Shen
Chiung-chyi
CC
Sun
Ming-hsi
MH