Role of intraoperative ultrasonography as a method of neuro-navigation in surgical treatment of intracranial hemorrhage.

Background: Spontaneous intracranial hemorrhage (ICH), the second most common type of stroke, can be fatal or cause severe disability. A key technical goal while studying the surgical therapy of ICH should be the amount of hematoma evacuation. Multiple challenges are encountered while dealing with ICH cases, including the removal of a sufficient part of the hematoma with the least residual volume that can be considered acceptable for optimal functional outcome. Minimizing cortical damage and choosing the safest approach that can achieve maximal evacuation of the hematoma must be top priorities. For all the foregoing, intraoperative ultrasound (IOUS) has been proposed as a capable technique for the purpose of localizing the bleeding and tracking its evacuation in real-time. Methods: This is a retrospective study, including thirty patients with ICH treated in Neurosurgery departments in Fayoum and Cairo University hospitals from July 2017 to June 2024. Patients were operated upon with the help of IOUS. The benefit of using IOUS for achieving maximal evacuation was assessed according to the presence of residual hemorrhage in postoperative computed tomography (CT) or magnetic resonance imaging (MRI) compared to the preoperative radiological studies. Results: Regarding the epidemiological characteristics of the study group, the patients' mean age of 44.86 ± 19.5 years was observed, with ages ranging from 13 to 75 years. 60% of the participants were males, while 40% were females. Considering the site of the hematoma, clots were observed in 33% of the subjects within the parietal lobe. In 30%, they were in the frontal lobe. 17% of bleeds were temporal, 13% were in the basal ganglia, and 7% were seen in the posterior fossa. With a standard deviation of 15.4 cc and a range of 13-80 cc, the average hematoma size as determined by CT/MRI was 34.5 cc. Furthermore, according to the US, the average size of the hematoma was 34.62 cc, with a standard deviation of 15.5 cc, and a range of 12-81 cc. Ultrasound (US) findings: when compared to control CTs, US had a sensitivity of 91.6% and a specificity of 100% for detecting residual hematoma following surgery, for a total accuracy of 96%. Conclusion: Neuro-navigation using US is a simple, quick, and risk-free method of real-time imaging for a variety of neurosurgical operations. It reduces the amount of brain exploration, the extent of dural incisions, and, hopefully, surgical morbidity while accurately identifying and localizing intracranial hematomas. In the absence of sophisticated radiological equipment, it provides generally agreed guidelines for maximizing evacuation.