Spontaneous Intracerebral hemorrhage (ICH) is a severe neurological emergency with high mortality and disability. While traditional craniotomy offers no clear functional benefit over medical treatment, minimally invasive surgery (MIS) has shown moderate outcome improvements in lobar ICH. However, its wider use is limited by challenges in device guidance, and high costs techniques. This technical note seeks to detail our original approach using “exclusive” ultrasound-guided MIS (US-guided MIS).

We present a technical note and preliminary results of US-guided MIS for ICH management, based on eight cases (four spontaneous and four secondary ICH). The procedure targeted hematomas in cerebellar, deep brain, and lobar regions, with intraventricular hemorrhage extension in five cases.

At admission, patients had a mean GCS of 11 ± 4.7 and NIHSS of 14.7 ± 4.8. US-guided MIS was performed at a median delay of 5.6 h (IQR 3.8–22.7), with a mean procedure duration of 40 ± 19.1 min and an average hospital stay of 33.2 ± 25.9 days. Spontaneous ICH volume decreased from 67.7 ± 25.1 mL (31.2–86.4) to 15.7 ± 7 mL (7–22), corresponding to 76.8 ± 6% (69.4–84.03%) clearance. Spontaneous lobar hematomas exhibited a higher mean clearance rate (79.2 ± 4.2%) compared with the single case involving a deep hematoma (69.4%). No intraoperative complication was observed. The mean post-operative GCS and NIHSS were respectiveley 11 ± 4.3 and 12 ± 9.8. At discharge, two patients had favorable outcomes (mRS 0–2), three had severe disability (mRS 5), and three died during hospitalization (mRS 6).

US-guided MIS is simple and effective for intracerebral hematoma evacuation. Larger randomized controlled trials are needed to establish its place, especially compared to other MIS techniques, versus medical treatment in ICH management.