Evaluation of intraoperative color Doppler ultrasonography in the surgical evacuation of acute intracranial hematoma: a single-center study from Botswana

Background Achieving accurate intraoperative localization of intracranial hematomas is essential for maximizing evacuation efficiency and minimizing neurological injury. Conventional preoperative CT provides static imaging and cannot reflect dynamic hematoma evolution during surgery, particularly in acute settings. Objective To evaluate the effectiveness of intraoperative color Doppler ultrasonography in improving hematoma clearance and neurological outcomes in patients undergoing craniotomy for acute intracranial hemorrhage, and to assess its feasibility in resource-limited environments. Methods In this prospective randomized study, 57 patients with acute supratentorial intracranial hematomas (including epidural, subdural, and intraparenchymal hemorrhages) were allocated to either an observation group receiving intraoperative color Doppler ultrasonography guidance ( n = 34) or a control group undergoing conventional surgery based on preoperative CT alone ( n = 23). Hematoma clearance rate, Glasgow Coma Scale (GCS), National Institutes of Health Stroke Scale (NIHSS), and length of hospital stay were compared between groups. Results The proportion of patients achieving >90% hematoma clearance was significantly higher in the ultrasound-guided group (70.6% vs. 26.1%, P < 0.001). Two weeks postoperatively, the observation group demonstrated better neurological recovery, with higher GCS scores [12 (10–12) vs. 9 (8–10), P < 0.001] and lower NIHSS scores (8.38 ± 2.15 vs. 11.78 ± 2.15, P < 0.001). The ultrasound-guided group also had a shorter hospital stay (12.47 ± 5.34 vs. 16.39 ± 7.38 days, P = 0.024). Intraoperative ultrasonography successfully detected residual, newly formed, and contralateral hematomas that were not identified on preoperative CT. Conclusion Intraoperative color Doppler ultrasonography enables precise, real-time hematoma localization. It provides additional dynamic information beyond static preoperative imaging, potentially improving surgical clearance rates and short-term neurological outcomes in patients with acute supratentorial hematomas. This technique is a practical adjunct to CT-guided neurosurgery, particularly in resource-constrained settings.