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CC BY 4.0 · J Neurol Surg Rep 2025; 86(04): e214-e223
DOI: 10.1055/a-2713-5817
Original Report

An Affordable In-house Tubular Retractor for Evacuation of Intracerebral Hematomas: A Case Series and Literature Review

Authors

  • Wilairat K. Kaewborisutsakul

    1   Anatomy Program, Faculty of Sciences, Prince of Songkla University, Songkla, Thailand

  • Anukoon Kaewborisutsakul 

    2   Department of Surgery, Faculty of Medicine, Neurological Surgery Unit, Prince of Songkla University, Hat Yai, Songkhla, Thailand

  • Surapong Chatpun

    3   Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand

  • Kwunchit Oungbho

    4   Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, Thailand

  • Waritorn Srakhao

    5   Translational Medicine Research center, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand

  • Kanisorn Sungkaro

    2   Department of Surgery, Faculty of Medicine, Neurological Surgery Unit, Prince of Songkla University, Hat Yai, Songkhla, Thailand

  • Chin Taweesomboonyat

    2   Department of Surgery, Faculty of Medicine, Neurological Surgery Unit, Prince of Songkla University, Hat Yai, Songkhla, Thailand

Funding Information This work was supported by the National Science, Research, and Innovation Fund (NSRF) and the Prince of Songkla University (grant number MED6505161S) for developing and making the in-house tubular retractor. Funding from the Faculty of Medicine, Prince of Songkla University supported the English editing. The funders had no role to play in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
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Abstract

Background

Intracerebral hemorrhage (ICH) disproportionately affects low- and middle-income countries (LMICs), where prevalence and outcomes are poor. Surgical intervention is often necessary in life-threatening cases. This study explored the feasibility of using a low-cost, in-house tubular retractor for ICH evacuation in a resource-limited setting.

Methods

We retrospectively reviewed adults with spontaneous supratentorial ICH who underwent evacuation with an International Organization for Standardization (ISO)-compliant, in-house tubular retractor (production cost approximately $60) between January 2023 and June 2024. Outcomes included hematoma volume reduction, correction of midline shift, perioperative complications, reoperation, hospital stay, and Glasgow Coma Scale (GCS) scores at discharge and 6 months.

Results

A total of 18 patients (13 males, 5 females; mean age 60.6 ± 13.8 years) underwent surgery. Median hematoma volume was 65.3 cm3 (IQR, 48.5–93.8), with a mean reduction of 81.2% ± 11.7 (median 83.9% [IQR 73.4–88.3]). Midline shift correction averaged 58.5% ± 28.0 (median 55.9% [IQR 43.7–69.6]). Hematoma evacuation was similar whether surgery occurred within 6 hours or later (79.8% vs. 83.5%, p = 0.49). Putaminal and frontal hematomas (n = 14) showed greater reduction than non-putaminal (n = 4), though not statistically significant. Median hospital stay was 23.5 days (IQR, 14.5–50.5). At 6 months, median GCS improved from 13 (IQR, 9–14) at discharge to 15 (IQR, 12–15). Two patients died of non-neurological causes.

Conclusion

Use of an in-house, ISO-compliant tubular retractor is feasible and cost-effective for intracerebral hematoma evacuation in resource-limited settings. These preliminary findings support further investigation to refine the technique and assess its clinical impact.

Keywords

stroke - tubular retractor - endoport - minimal invasive surgery

Contributors' Statement

A.K.: conceptualization, data curation, formal analysis, writing—original draft; W.K.K.: methodology, data curation, writing—original draft; S.C.: supervision, data curation; K.O.: supervision, data curation; W.S.: project administration, data curation; K.S.: data curation; C.T.: data curation. All authors reviewed and approved the final manuscript.




Publikationsverlauf

Eingereicht: 05. März 2025

Angenommen: 21. September 2025

Artikel online veröffentlicht:
15. Oktober 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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