• Tomoaki Murakami, Shingo Toyota, Shuki Okuhara, Motohide Takahara, Kazuhiro Touhara, Yuhei Hoshikuma, Shuhei Yamada, Takamune Achiha, Takeshi Shimizu, Maki Kobayashi, and Haruhiko Kishima.
• Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
• World Neurosurg. 2024 Sep 1; 189: e598e604e598-e604.

ObjectiveBy maximizing the advantages of exoscopy, we developed a keyhole approach for intracranial hematoma removal. Herein, we validated the utility of this procedure, and compared it with conventional microscopic hematoma removal and endoscopic hematoma removal in our institution.MethodsWe included 12 consecutive patients who underwent this procedure from June 2022 to March 2024. A 4-cm-long skin incision was made, and a keyhole craniotomy (diameter, 2.5 cm) was performed. An assistant manipulated a spatula, and an operator performed hematoma removal and hemostasis using typical microsurgical techniques under an exoscope. The dura mater was reconstructed without sutures using collagen matrix and fibrin glue. The outcomes of this series were compared with those of 12 consecutive endoscopic hematoma removals and 19 consecutive conventional microscopic hematoma removals from October 2018 to March 2024.ResultsThe mean age was 72±10 years, and 7 (58%) patients were men. Hematoma location was the putamen in 5 patients and subcortical in 7 patients. The mean operative time was 122±34 min, the mean hematoma removal rate was 95%±8%, and the mortality rate was 0%. Although the preoperative hematoma volume was similar between the 3 groups, the operative time and total time in the operating room was significantly shorter in the exoscope group than in the microscope group (P<0.0001).ConclusionsThis procedure may be simpler and faster than conventional microscopic hematoma removal, and comparable to endoscopic hematoma removal.Copyright © 2024 Elsevier Inc. All rights reserved.

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