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Updated: Sep 10, 2025
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Conventional Craniotomy and Neuroendoscopic Surgery for Patients with Hypertensive Intracerebral Hemorrhage: A
John Emmanuel Y Custodio1, Joseph Erroll V Navarro1, Oliver Ryan M Malilay1
1Section of Neurosurgery, Department of Surgery, Jose R. Reyes Memorial Medical Center, Santa Cruz, Manila, Philippines.
Insights
Comparing surgical options for spontaneous intracerebral hemorrhage, this study found both conventional craniotomy and neuroendoscopic surgery offer similar mortality and functional outcomes. Neuroendoscopic surgery, however, demonstrated a significantly shorter operative time for patients with primary spontaneous intracerebral hemorrhage.
Area of Science:
- Neurosurgery
- Neurology
- Medical Technology
Background:
- Primary spontaneous intracerebral hemorrhage (PSICH) is a significant cause of mortality and disability.
- Emergent hematoma evacuation is crucial for deteriorating patients with large hematoma volumes.
- Conventional craniotomy and neuroendoscopic surgery are surgical options for PSICH management.
Purpose of the Study:
- To compare the efficacy of conventional craniotomy versus neuroendoscopic surgery for PSICH.
- To evaluate differences in mortality, functional outcomes, hematoma clearance, and complications.
- To determine the optimal surgical approach for PSICH patients.
Main Methods:
- A meta-analysis and review of eligible studies were conducted.
- Searched multiple databases including Cochrane, PubMed, Embase, and WHO ICTRP.
- Included patients aged 18-60 with deep hypertensive intracerebral hemorrhage treated within 24 hours.
Main Results:
- No statistically significant difference in postoperative mortality or functional outcomes between the two surgical methods.
- Neuroendoscopic surgery was associated with a significantly shorter operative time.
- Both approaches showed similar hematoma clearance, intraoperative blood loss, rebleeding rates, and hospital stay.
Conclusions:
- Conventional craniotomy and neuroendoscopic surgery provide comparable mortality and functional outcomes for PSICH.
- Neuroendoscopic surgery offers the advantage of reduced operative time.
- Both surgical techniques are effective in evacuating hematoma and managing complications.
Abstract:
Primary spontaneous Intracerebral Hemorrhage (PSICH) is a devastating disease occurring in 24.6 cases per 100,000 people per year, more common with chronic arterial hypertension. Emergent hematoma evacuation remains a lifesaving intervention especially in younger patients with large hematoma volume and are clinically deteriorating. Timely and appropriate management is key to improving outcomes. In this study, we compared whether conventional craniotomy or neuroendoscopic surgery would lead to improved mortality and better functional outcomes in patients with PSICH. Specifically, we wanted to determine the extent of hematoma clearance, intraoperative blood loss, intraoperative time, degree of rebleeding, total complications, and length of hospital stay among the surgical approaches utilized. We searched from the Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE/PubMed, the U.S. National Institutes of Health Ongoing Trials Register, Embase database, Health Research and Development Information Network (HERDIN), and the World Health Organization International Clinical Trials Registry Platform for studies to be included. Patients with deep hypertensive intracerebral hemorrhage of either sex, aged 18 to 60 years, with a Glasgow Coma Score of 6 to 12, with hematoma volume of 30 to 80 mL, and received treatment within 24 hours with either conventional craniotomy or neuroendoscopic surgery were allowed. Outcomes evaluated were mortality and functional outcome. The risk of bias was assessed using the ROBINS-I tool for nonrandomized studies. The final search yielded four eligible studies. Both conventional craniotomy and neuroendoscopic surgery did not show any statistically significant difference in postoperative mortality (risk ratio [RR]: 1.32, 95% confidence interval [CI]: 0.48-3.62, p = 0.59, I 2 : 42%) and postoperative functional outcome (RR: 3.17, 95% CI: 0.76-13.3, p = 0.11, I 2 : 83%). Neuroendoscopic surgery showed statistically significant shorter operative time. Both interventions yielded similar results in amount of volume evacuated, intraoperative blood loss, length of hospital stay, number of rebleeding, and total complications. This meta-analysis and review shows that conventional craniotomy and neuroendoscopic surgery both lead to good postoperative functional outcomes with similar death rates. Neuroendoscopic surgery showed statistically significant shorter operative time. Both interventions result in high volume of hematoma evacuated, low number of rebleeding, and total complications, as well as similar amount of intraoperative blood loss and length of hospital stay.
