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Minimally Invasive Surgery Versus Open Craniotomy With Clot Evacuation After Intracerebral Hemorrhage
Santosh B Murthy1, Cenai Zhang1, Andrew L A Garton2
1Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY.
Annals of Neurology
|December 30, 2025
Summary
Minimally invasive surgery (MIS) for spontaneous intracerebral hemorrhage (sICH) shows better outcomes than open craniotomy. MIS is linked to lower mortality and improved discharge disposition in a large US study.
Area of Science:
- Neurosurgery
- Stroke Medicine
- Minimally Invasive Procedures
Background:
- Spontaneous intracerebral hemorrhage (sICH) is a severe condition with high mortality.
- Surgical interventions aim to improve outcomes, with minimally invasive surgery (MIS) emerging as a potential alternative to open craniotomy.
- Comparative effectiveness data for MIS versus open craniotomy in sICH is limited.
Purpose of the Study:
- To evaluate the association between minimally invasive surgery (MIS) and clinical outcomes compared to open craniotomy for spontaneous intracerebral hemorrhage (sICH).
- To test the hypothesis that MIS offers superior outcomes in a large, nationwide US patient cohort.
Main Methods:
- Retrospective cohort study using the American Heart Association Get With The Guidelines-Stroke registry (2011-2021).
- Included patients with sICH who underwent either MIS (endoscopic or stereotactic evacuation) or open craniotomy.
- Used overlap-weighted propensity score matching and logistic regression to analyze in-hospital mortality, discharge disposition, and functional status (modified Rankin Scale).
Main Results:
- Among 7,770 surgically treated sICH patients, 703 received MIS and 7,067 underwent open craniotomy.
- MIS was associated with significantly lower odds of in-hospital mortality (aOR=0.7) and unfavorable discharge (aOR=0.7).
- Patients undergoing MIS had higher odds of discharge to rehabilitation (aOR=1.3) but no significant difference in functional outcomes.
Conclusions:
- Minimally invasive surgery (MIS) is associated with reduced in-hospital mortality and better discharge disposition for spontaneous intracerebral hemorrhage (sICH) compared to open craniotomy.
- These findings support the use of MIS in selected sICH patients.
- Further research may explore long-term functional outcomes and cost-effectiveness.
