A novel rapid surface projection localization technique (RSPLT) using 3D slicer and smartphone-assisted registration for keyhole evacuation of intracerebral hematomas.

To develop and validate a novel rapid surface projection localization technique (RSPLT) using 3D Slicer and smartphone-assisted registration for precise keyhole evacuation of intracerebral hematomas. Technical workflow of RSPLT was established: (1) 3D Slicer-based hematoma reconstruction and sagittal plane optimization; (2) Transparent overlay of hematoma contours onto scalp morphology; (3) Smartphone-leveler guided via anatomical landmarks. The technique was applied in 28 consecutive ICH cases, with intraoperative validation of localization accuracy. RSPLT achieved complete hematoma projection within 7.98 ± 1.18 min (range 6.1-9.8 min). Intraoperative validation using caliper measurement confirmed sub-millimeter surface landmark registration error (1.2 ± 0.3 mm). The technique enabled minimal access (bone window 3.10 ± 0.63 cm, range 2.3-5.4 cm) with 95.31 ± 5.56% clearance (range 78.2-99.74%), suggesting it may offer a potentially more efficient alternative to conventional CT-guided planning. Postoperative ADL scores improved significantly from 53.12 ± 5.63 to 83.17 ± 9.54 at three months. This proof-of-concept study demonstrates that RSPLT can provide a rapid, low-cost, and accurate approach for hematoma spatial mapping, which may aid in the precision of keyhole trajectory design. These preliminary from a single-center experience findings warrant further comparative studies to validate its clinical utility against existing methods.