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.

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.

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.

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.

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.

Received: 05 March 2025

Accepted: 21 September 2025

Article published online:
15 October 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/)

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany