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, particularly in resource-limited environments, highlighting its significance.

Key Findings:

• 70.6% of the ultrasound-guided group achieved >90% hematoma clearance compared to 26.1% in the control group (P < 0.001).
• The ultrasound-guided group had higher GCS scores (12 vs. 9, P < 0.001) and lower NIHSS scores (8.38 vs. 11.78, P < 0.001) two weeks postoperatively.
• Shorter hospital stay for the ultrasound-guided group (12.47 days vs. 16.39 days, P = 0.024).
• Intraoperative ultrasonography detected residual, newly formed, and contralateral hematomas not visible on preoperative CT.

Interpretation:

Intraoperative color Doppler ultrasonography provides real-time, dynamic information that enhances surgical clearance rates and improves short-term neurological outcomes in patients with acute supratentorial hematomas, with significant implications for clinical practice.

Limitations:

• Single-center study may limit generalizability and affect the robustness of findings.
• Small sample size may affect the robustness of findings.
• Exclusion of certain hemorrhage types limits applicability and may skew results.

Conclusion:

Intraoperative color Doppler ultrasonography is a practical adjunct to CT-guided neurosurgery, particularly beneficial in resource-constrained settings, enhancing surgical outcomes for acute intracranial hematomas and potentially improving patient outcomes.