Stereotactic catheter aspiration was conducted using either a stereotactic frame (Leksell Vantage, Elekta, Stockholm, Sweden) or frameless stereotactic navigation system (BrainLab AG, Munich, Germany). All surgeries were conducted by a well-trained surgical team (Q.L, Z.W, Y.Z).
Surgical procedures were based on the method described in previous studies [3 (link),18 (link)]. Briefly, a thin-section CT scan (1 mm or 1.5 mm) was performed before surgery for the frame parameter or frameless navigation data construction. The puncture point and trajectory were designed along the long axis of the hematoma. The catheter was placed into the hematoma through a sheath into the precalculated depth. The hematoma was gently aspirated using a 10 mL volume syringe at multiple sites along the long axis of the hematoma until resistance was reached. The sheath depth was adjusted to aspirate the remaining hematoma. Saline was used to wash the hematoma cavity until no further blood clots could be aspirated. An additional CT scan was performed after surgery to determine the location of the catheter and the residual hematoma. Next, 50,000 units of urokinase were injected into the hematoma cavity if the residual hematoma was more than 10 mL. The catheter was generally retained for 1–3 days depending on the amount of fluid drainage and the result of repeated CT scans.
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