Portable ultrasound-guided Trans-sylvian minimally invasive intracerebral hemorrhage surgery: how I do it.

Background: Intracerebral hemorrhage (ICH) is a common neurosurgical emergency with high morbidity and mortality. The trans-sylvian microsurgical evacuation of ICH in the basal ganglia is a classic but technically challenging approach.

Method: We describe a novel technique using handheld portable ultrasound to guide trans-sylvian, trans-insular evacuation of basal ganglia hematomas, allowing for rapid identification, precise evacuation, and post-evacuation assessment from a small Sylvian fissure opening.

Conclusion: Intraoperative portable ultrasonography is a rapid, simple, and inexpensive technique that provides real-time visualization of ICH and key cortical structures, minimizing potential damage during exposure and exploration.